Exfoliative Dermatitis

Written by Erica Roth | Published on August 22, 2012
Medically Reviewed by Brenda B. Spriggs, MD, MPH, FACP

What is Exfoliative Dermatitis?

Exfoliative dermatitis is 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 of the skin. The skin peeling may be associated with pre-existing medical conditions in some people, while in others the cause is unknown.

Exfoliative dermatitis, sometimes called erythroderma, is serious but fairly uncommon. Complications can include infection, loss of nutrients, and dehydration.

Causes of Exfoliative Dermatitis

The root cause of exfoliative dermatitis is a disorder of the skin cells. The cells die and are 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 described as “sloughing.”

Underlying Conditions

Many people who already suffer from chronic skin conditions, including autoimmune diseases, psoriasis, and eczema, can also develop exfoliative dermatitis.

Drug Reactions

Adverse reactions to a variety of drugs can also contribute to massive skin scaling. Drugs that may produce this condition include:

  • sulfa drugs
  • penicillin
  • barbituates
  • phenytoin (Dilantin)
  • isoniazid

Other Causes

Certain types of cancer, including leukemia and lymphoma, may also cause the skin cell turnover rate to accelerate. However, up to 25 percent of cases have idiopathic exfoliative dermatitis (Merck, 2009). “Idiopathic” is the term used to describe a disease or condition without a known cause.

Symptoms of Exfoliative Dermatitis

Skin and Body changes

Exfoliative dermatitis begins in most people with extreme reddening over large portions of the body. This change in skin color is called erythroderma. “Erythroderma” and “exfoliative dermatitis” are terms sometimes used interchangeably. Massive peeling of the skin follows the reddening and inflammation. The skin may be rough and scaly or leather-like in appearance. The dryness and peeling of your skin can cause itching and pain. Your nails may also become thicker and more ridged.

Flu-Like Symptoms

People who have exfoliative dermatitis may also suffer from flu-like symptoms, such as fever and chills. This is because widespread skin peeling can affect your internal thermometer. In other words, your body is not able to control its temperature well.

Complications from Skin Shedding

Those who suffer from this condition may also have a lower-than-normal blood volume. This is caused by loss of fluid through the skin that has been shed.

Skin shedding may start in small patches, but over time spreads to most of the body. Skin is composed mainly of protein and serves as a means to deliver nutrients to your other organs. The constant shedding of the skin can prevent your body from absorbing essential nutrients. You also lose protein from the sloughing. Dehydration and malnutrition are thus common complications.

Severe Symptoms

Severe symptoms of exfoliative dermatitis can be life threatening. Mortality rates are highest in patients who develop complications of infection, fluid and electrolyte abnormalities, and cardiac failure. The most common causes of death in patients with exfoliative dermatitis are pneumonia, septicemia, and heart failure (Karakayli, et al., 1999).

Treatment for Exfoliative Dermatitis

You will probably be treated for exfoliative dermatitis in the hospital. Inpatient care is essential to correct dehydration, low blood volume, and nutritional deficiencies. Your doctor will administer intravenous fluids and nutrients to treat these complications.

Reducing inflammation and making you more comfortable are the main 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.

Oral and topical steroid medications are used to treat severe inflammation and flaking of the skin in many patients (Karakayli, et al., 1999). Some patients may benefit from phototherapy (PUVA), treatments with psoralen, a photosensitizing agent, and ultraviolet A. Immunosuppressant drugs can be prescribed to cause the immune system to slow the rate of skin shedding.

Antibiotics can both treat and prevent skin infections, that are especially dangerous and a serious complication of this condition.

Your doctors will also manage any underlying conditions that aggravate your dermatitis. You will probably need to stop taking medications that could cause allergic skin reactions.

Long-Term Outlook for Exfoliative Dermatitis

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. Managing conditions such as cancer and psoriasis can speed healing too. People with idiopathic forms of the disease may suffer from flare-ups throughout their lives (Merck, 2009).

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