Exfoliative Dermatitis

Exfoliative dermatitis, a cutaneous reaction produced in response to a drug or a chemical agent or to an underlying systemic disease, is a condition in which most or all of the skin surface is involved with a scaly erythematous dermatitis. Males are affected twice as often as females, and most patients are over the age of 40. 10 The mechanisms responsible are not known although drug-induced exfoliative dermatitis may be mediated by an increased activity of sensitized suppressor-cytotoxic T lymphocytes.

Exfoliative dermatitis can have an abrupt onset, particularly when related to a drug, contact allergen, or malignancy, whereas exacerbations related to an underlying cutaneous disorder usually evolve more slowly. In many cases, exfoliative dermatitis tends to be a chronic condition with a mean duration of five years when related to a chronic illness; a shorter course often follows suppression of the underlying dermatosis, discontinuation of causative drugs, or avoidance of allergen. Both idiopathic and chronic disease-related exfoliative dermatitis can continue for 20 or more years; death is rare.

Generalized erythema and warmth are noted and are similar to that seen in the patient with TEN, but skin tenderness is usually lacking. Erythema is accompanied by scaling or flaking and the patient often complains of pruritus and skin tightness [ F|g..,.241-2 (Plate 28)]. The process usually begins on the face and upper trunk with progression to other skin surfaces. The patient usually has a low-grade fever. Excessive heat loss and hypothermia can complicate erythroderma. Widespread cutaneous vasodilation may result in high-output congestive heart failure. The disruption of the epidermis results in increased transepidermal water loss, and continued exfoliation can result in significant protein loss and negative nitrogen balance. Chronic inflammatory exfoliation produces many changes, such as dystrophic nails, thinning scalp and body hair, and patchy or diffuse pigmentation changes.

FIG. 241-2 (P|a$.e...,2.8). Exfoliative dermatitis—generalized, warm erythema accompanied by scaling or flaking.

The differential diagnosis of exfoliative dermatitis includes staphylococcal scalded skin syndrome, EM, TEN, toxic shock syndrome (staphylococcal and streptococcal), and Kawasaki disease. Considerable effort must be made to determine the underlying etiology, including evaluation for underlying malignancy, and biopsy of involved skin. Patients generally require emergent dermatologic consultation and admission. Hypothermia and hypovolemia should be corrected, and systemic corticosteroids are often given after consultation.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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