Merck Manual

Please confirm that you are not located inside the Russian Federation

Loading

Exfoliative Dermatitis

(Erythroderma)

By

Mercedes E. Gonzalez

, MD, University of Miami Miller School of Medicine

Last full review/revision Mar 2018| Content last modified Mar 2018
Click here for the Professional Version
NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version

Exfoliative dermatitis is severe inflammation that causes the entire skin surface to become red, cracked, and covered with scales, and the top layer of the skin comes off (exfoliates).

Certain drugs (especially penicillins, sulfonamides, isoniazid, phenytoin, and barbiturates) may cause this disorder. In some cases, it is a complication of other skin diseases, such as atopic dermatitis, psoriasis, and contact dermatitis. Certain lymphomas (cancers of the lymph nodes) and other cancers, such as leukemia, may also cause exfoliative dermatitis. In up to 25% of people, the cause is unknown.

Symptoms

Exfoliative dermatitis may start rapidly or slowly. At first the entire skin surface becomes red and shiny. Then the skin becomes scaly, thickened, and sometimes crusted. The top layer of skin, the epidermis, falls off over large parts of the body. Sometimes the hair and nails fall out. Some people have itching and swollen lymph nodes.

Although many people have a fever, they may feel cold and have chills because so much heat is lost through the damaged skin. Large amounts of fluid, electrolytes (such as sodium, potassium, and calcium), iron, and protein may seep out. The damaged skin is a poor barrier against infection, so the skin may become infected by bacteria.

Diagnosis

  • A doctor's evaluation

  • Possibly skin biopsy to rule out cancer

Doctors base the diagnosis of exfoliative dermatitis on the person's history and the results of a physical examination.

If symptoms of exfoliative dermatitis are similar to those of a skin lymphoma (mycosis fungoides), doctors send samples of skin to the laboratory to rule out lymphoma as a cause.

Prognosis

Exfoliative dermatitis may be life threatening, but the prognosis depends on the cause. Exfoliative dermatitis caused by drugs lasts 2 to 6 weeks after the drug is stopped.

Treatment

  • Often hospitalization for supportive care

  • Skin care

  • Treatment of underlying cause

Early diagnosis and supportive treatment of exfoliative dermatitis are important in preventing infection from developing in the affected skin and in keeping fluid and protein loss from becoming life threatening.

People with severe exfoliative dermatitis often need to be hospitalized and given antibiotics (for infection), fluids and salts (to replace those lost through the skin) by vein (intravenously), and nutritional supplements. Care may include the use of drugs and heated blankets to control body temperature. Cool oatmeal baths followed by applications of petroleum jelly and gauze may help protect the skin. Corticosteroids (such as prednisone) given by mouth or intravenously are used only when other measures are unsuccessful or the disease worsens.

Any drug or chemical that could be causing exfoliative dermatitis should be stopped or avoided. If lymphoma is causing exfoliative dermatitis, treatment of the lymphoma is helpful.

Drugs Mentioned In This Article

Generic Name Select Brand Names
RAYOS
LANIAZID
DILANTIN
NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
Others also read

Also of Interest

Videos

View All
Acne
Video
Acne
The skin contains many tiny hair follicles, or pores. Each pore contains a hair and a multi-lobed...
3D Models
View All
Lymphangitic Streak
3D Model
Lymphangitic Streak

SOCIAL MEDIA

TOP