Dermatitis, Exfoliative

Dermatitis, Exfoliative is a topic covered in the 5-Minute Clinical Consult.

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Basics

  • Exfoliative dermatitis (ED), or erythroderma, is a rare disorder characterized by generalized redness and scaling involving >90% of the skin.
  • It may develop idiopathically (primary erythroderma) or arise as a generalization of a preceding localized skin disease or reaction to a medication (secondary erythroderma).
  • ED may appear suddenly or gradually, occasionally accompanied by fever, chills, and lymphadenopathy.
  • When fulminant, ED is potentially life-threatening.

Description

  • Cutaneous involvement consists of redness and/or scaling of most of the skin (>90%).
  • System(s) affected: skin/exocrine
  • Synonym(s): erythroderma; exfoliative erythroderma; red man syndrome (l’homme rouge)

Epidemiology

Incidence
  • In the United States: rare; estimated 1% of hospitalizations for skin disease
  • Predominant age: >40 years, except when it results from hereditary ichthyoses, or immunodeficiencies, which are most common in the pediatric age group
  • Predominant sex: male > female (2 to 4:1)
  • No racial predilection

Etiology and Pathophysiology

  • Arises idiopathically in up to 20–30% of cases. It can also arise secondary to an underlying cutaneous or systemic disease (see the following text) or as a reaction to medications.
  • The mechanisms behind generalization of preexisting skin disease is not well understood. In erythrodermic skin, keratinocytes exhibit an increased mitotic rate and increased transit time through the epidermis.

Risk Factors

  • Underlying diseases, as noted in the following text
  • Certain medications, as noted in the following text
  • Male sex
  • Age >40 years

Commonly Associated Conditions

  • Most commonly associated conditions or diseases reported that present with/develop into ED include the following:
    • Psoriasis (most common cause in adults)
    • Drug reaction (most common cause in children)
    • Atopic dermatitis
    • Cutaneous T-cell lymphoma (CTCL, mycosis fungoides)
    • Idiopathic in up to 20–30% of cases
  • Less commonly, ED has been noted as a finding in the following skin disorders:
    • Allergic contact dermatitis
    • Stasis dermatitis with secondary autoeczematization
    • Pityriasis rubra pilaris (a rare disorder of keratinization)
    • Graft-versus-host disease
    • Seborrheic dermatitis (Leiner disease) in infants
    • Ichthyosiform dermatoses
    • Pemphigus foliaceus
    • Papulosquamous dermatitis of AIDS
    • Fungal disease with id reaction
  • Other rare reported associations include the following:
    • Reiter syndrome
    • Systemic lupus erythematosus
    • Hailey-Hailey disease
    • Norwegian scabies
    • Sarcoidosis
    • Lichen planus
    • Dermatomyositis
  • Medications: may occur as a reaction to the following drugs: allopurinol, antimalarials, aspirin, barbiturates, captopril, codeine, cefoxitin, cimetidine, dapsone, gold salts, hydantoin, isoniazid, lithium, NSAIDs, omeprazole, para-aminosalicylic acid, penicillin, phenylbutazone, phenothiazine, St. John’s wort, sulfonamide, sulfonylurea, thalidomide, and vancomycin
  • May occur as a complication or presenting symptom of the following malignancies (paraneoplastic ED):
    • Mycosis fungoides (CTCL)
    • Sézary syndrome (leukemic variant of mycosis fungoides)
    • Hodgkin disease
    • Non-Hodgkin lymphoma and leukemia

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Citation

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TY - ELEC T1 - Dermatitis, Exfoliative ID - 816157 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816157/all/Dermatitis__Exfoliative PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -