Exfoliative dermatitis is redness and peeling of the skin over large areas of the body. The term “exfoliative” refers to the exfoliation, or shedding, of the skin. Dermatitis means irritation or inflammation of the skin. The skin peeling may occur with pre-existing medical conditions or medications in some people. The cause is unknown in others.
Exfoliative dermatitis, sometimes called erythroderma, is serious but fairly uncommon. Complications can include infection, loss of nutrients, dehydration, and heart failure, rarely leading to death.
The root cause of exfoliative dermatitis is a disorder of the skin cells. The cells die and shed too quickly in a process called turning over. The rapid turnover of skin cells causes significant peeling and scaling of the skin. The peeling and scaling may also be known as sloughing.
Many people who already suffer from chronic skin conditions, including autoimmune diseases, psoriasis, seborrheic dermatitis, and eczema, can also develop exfoliative dermatitis.
Adverse reactions to a variety of drugs can also contribute to massive skin peeling. Drugs that may produce this condition include:
- sulfa drugs
- phenytoin (Dilantin) and other seizure medications
- blood pressure medications
- calcium channel blockers
- topical medications (medications put on the skin)
However, almost any drug can cause exfoliative dermatitis.
Certain types of cancer, including leukemia and lymphoma, may also accelerate the skin cell turnover rate. According to Merck Manuals, up to 25 percent of cases of exfoliative dermatitis are idiopathic. Idiopathic is when a disease or condition has no known cause.
Skin and Nail Changes
Exfoliative dermatitis begins in most people with extreme reddening, which spreads over large portions of the body. This change in skin color is known as erythroderma. Erythroderma and exfoliative dermatitis are both names for this condition. Massive peeling of the skin follows the reddening and inflammation. The skin may be rough and scaly. The dryness and peeling of your skin can cause itching and pain. Your nails may also become thicker and more ridged.
People who have exfoliative dermatitis may also have flu-like symptoms, such as fever and chills. This is because widespread skin peeling can affect your internal thermometer and cause heat loss from your damaged skin. Your body isn’t able to control its temperature well. Most people with exfoliative dermatitis also feel generally ill.
Complications from Skin Shedding
Those with this condition may also have a low blood volume. This is due to loss of fluid through the shed skin.
Skin shedding may start in small patches, but over time, it spreads to most of the body. Skin is made of mainly protein. The constant shedding of the skin can prevent your body from absorbing essential nutrients that help to maintain a healthy epidermis (such as vitamins A and D). You also lose protein and fluids from the sloughing. Dehydration and protein deficiencies are common complications. Fluid and electrolyte levels should be monitored by you and your doctor.
Two important functions of your skin are providing a barrier to infections and other things in the environment, and protecting your inner organs. When your skin sheds significantly, it loses some of these abilities. This puts you at risk for serious infections and damage to underlying muscles and bones.
Severe symptoms of exfoliative dermatitis can be life-threatening. Those who develop complications of infection, fluid and electrolyte abnormalities, and cardiac failure are most at risk of death. The most common causes of death in patients with exfoliative dermatitis are pneumonia, septicemia, and heart failure.
You will probably receive treatment for exfoliative dermatitis in the hospital. Your doctor will work to correct any dehydration, low blood volume, heat loss, and electrolyte or nutritional deficiencies. Your doctor will give you IV fluids and nutrients to treat these complications.
Reducing inflammation and making you more comfortable are important goals of treatment. Supportive care includes warm baths, rest, and oral antihistamines. Your doctor may also prescribe medicated creams to moisten your dry, itchy skin.
Steroid medications treat severe or chronic inflammation and flaking of the skin. Some patients may benefit from phototherapy, treatments with psoralen, a photosensitizing agent, and ultraviolet A. Drugs that suppress the immune system can slow the rate of skin shedding, especially for people with chronic symptoms.
Infection can be a serious complication of this condition. Antibiotics can treat and prevent dangerous skin infections. Proper attention to wound care and dressings are also important to prevent infections.
Your doctors will also manage any underlying conditions. You will probably need to stop taking medications that could cause allergic skin reactions.
The outlook for exfoliative dermatitis varies for each patient. Drug allergies are the easiest to treat. Your skin usually clears up within several weeks after stopping the allergy-causing medication, along with appropriate treatment. Managing conditions such as cancer and psoriasis can speed healing too. People with no known cause for the disease may have flare-ups throughout their lives. People who have had exfoliative dermatitis may have long-lasting changes in the color of the affected skin. They may also have problems with hair loss or nail changes.