Exfoliative Dermatitis, (Erythroderma) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

This book describes Exfoliative Dermatitis, Diagnosis and Treatment and Related Diseases
Exfoliative dermatitis (Erythroderma) is the medical disorder where there is intense and normally widespread scaling, peeling, and flaking of the skin due to inflammatory skin disease.
It often occurs before or is linked with exfoliation (skin peeling off in scales or layers), when it may also be called exfoliative dermatitis (ED).
Idiopathic exfoliative dermatitis is occasionally called the ‘red man syndrome’.
It is often followed by, itching, skin redness (exfoliative dermatitis), and hair loss.
The most frequent skin disorders to cause exfoliative dermatitis are:
1. Drug eruption — with numerous diverse drugs implicated
2. Dermatitis especially atopic dermatitis
3. Psoriasis, especially after withdrawal of systemic steroids or other treatment
4. Pityriasis rubra pilaris
Other skin diseases that less often cause exfoliative dermatitis are:
1. Other forms of dermatitis:
a. contact dermatitis (allergic or irritant),
b. stasis dermatitis (venous eczema) and
c. in babies, seborrhoeic dermatitis or staphylococcal scalded skin syndrome
2. Blistering diseases such as pemphigus and bullous pemphigoid
3. Sezary syndrome (the erythrodermic form of cutaneous T-cell lymphoma)
Exfoliative dermatitis may also be a symptom or sign of a systemic disease.
1. Hematological malignancies, e.g. lymphoma, leukemia
2. Internal malignancies, e.g. carcinoma of rectum, lung, fallopian tubes, colon
3. Graft-versus-host disease
4. HIV infection
It is not known why some skin diseases in some people progress to exfoliative dermatitis.
The pathogenesis is complicated, with involvement of keratinocytes and lymphocytes, and their interaction with adhesion molecules and cytokines
Symptoms
Exfoliative dermatitis occurs often after morbilliform eruption, dermatitis, or plaque psoriasis.
Generalized erythema can form quite quickly in acute exfoliative dermatitis, or more slowly over weeks to months in chronic exfoliative dermatitis.
Generalized edema and erythema affects 90% or more of the skin surface.
The skin feels warm on contact.
Itch is normally worrisome, and is occasionally not tolerable.
Rubbing and scratching results in lichenification
Eyelid swelling may lead to ectropion
Scaling starts 2-6 days after the onset of erythema (red skin), as fine flakes or large sheets.
Thick scaling may form on the scalp with differing degrees of hair loss and ending in complete baldness.
Palms and soles may form yellowish, diffuse keratoderma
Nails become dull, thickened and ridged or form onycholysis and may break off
Lymph nodes become enlarged
Diagnosis:
Blood count may reveal anemia, white cell count abnormalities, and eosinophilia.
Marked eosinophilia should be suspicious for lymphoma.
>20% circulating Sezary cells indicates Sezary syndrome
Skin biopsies from several locations may be taken if the cause is not known.
They are likely to reveal non-specific inflammation on histopathology
Direct immunofluorescence is of use if an autoimmune blistering disease or connective tissue disease is indicated
Treatment:
Exfoliative dermatitis is possibly serious, even life-threatening
Most patients need hospitalization for monitoring of circulatory status and body temperature and to replace fluid and electrolyte balance.
These general measures apply:
1.Stop all medicines that are not needed
2.Check fluid balance and body temperature
3.Retain skin moisture with:
a.Wet wraps,
b.Other wet dressings,
c.Emollients and
d.Mild topical steroids
4.Antibiotics are given for bacterial infection
5.Antihistamines may decrease severe itch
6.Specific treatment for psoriasis and skin atopy

TABLE OF CONTENT
Introduction
Chapter 1 Exfoliative Dermatitis
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Steven Johnson Syndrome
Chapter 8 Erythema Multiforme
Epilogue