Exfoliative dermatitis (Erythroderma)

Introduction

Exfoliative Dermatitis refers to the involvement of all or most of the skin surface by a scaly erythematous dermatitis.
It is usually a secondary or reactive process to an underlying cutaneous or systemic disease.

Some causes of exfoliative dermatitis

  1. Contact dermatitis
  2. Atopic eczema
  3. Seborrhoeic dermatitis
  4. Drug eruptions
  5. Lichen planus and lichenoid eruptions
  6. Pediculosis corporis
  7. Crusted scabies
  8. Dermatophytosis
  9. Psoriasis
  10. Pemphigus foliaceus
  11. Lymphomas and leukaemia
  12. Ichthyosiform erythroderma
  13. Pityriasis rubra pilaris

Symptoms and clinical features of exfoliative dermatitis

Exfoliative dermatitis may be acute or chronic

  1. The irritating process is followed by a patchy erythema which spreads rapidly within 24 hours
  2. Pyrexia, malaise and shivering
  3. Scaling
  4. Irritation and tightness
  5. Skin feels cold
  6. The periorbital skin is inflamed and oedematous, resulting in ectropion, with consequent epiphora
  7. Moderate-to-gross generalized enlargement of lymph nodes in the absence of an underlying malignant lymphoma (dermatopathic lymphadenopathy)
  8. The nodes are rubbery in consistency
  9. The general picture is modified by the initial cause
  10. Pruritus is often intense if due to atopic eczema or lymphoma

Differential diagnoses

  • All the causes of exfoliative dermatitis listed above

Complications of exfoliative dermatitis

  1. Hypoalbuminaemia
  2. Hypothermia
  3. Dehydration
  4. Septicaemia
  5. Enteropathy
  6. High output cardiac failure
  7. Steatorrhoea
  8. Anaemia

Investigations

  • Full Blood count and differentials;
  • ESR, Urea and Electrolytes
  • Histopathology
  • Blood culture

Treatment for exfoliative dermatitis

Treatment objectives

  1. Restore the skin to normal
  2. Treat underlying disease
  3. Prevent or treat complications

Drug treatment

Systemic steroids in high doses

  • Prednisolone 40-60 mg orally per day

Treat impetiginization and septicaemia as appropriate (depending on results of culture and sensitivity).
Further treatment depends on the cause of exfoliative dermatitis

Adjuvant therapy

  1. Adequate hydration
  2. Emolients for skin (see Atopic eczema)
  3. Keep warm
  4. Adequate nursing care
  5. Appropriate nutrition and haematinics

Prevention of exfoliative dermatitis

  1. Avoid over-treatment of skin diseases and polypharmacy generally
  2. Do not abuse the skin with “medicated” soaps and herbal concoctions
  3. Get appropriate management of skin disease(s) from qualified personnel