Exfoliative dermatitis, sometimes called erythroderma, involves redness and peeling of the skin over
This skin peeling may occur due to pre-existing medical conditions or as a result of taking certain medications, but sometimes, it doesn’t have a clear cause.
While fairly uncommon, exfoliative dermatitis can, in some cases, lead to serious complications, including infection, loss of nutrients, dehydration, and heart failure. In rare cases, it can also be fatal.
Here’s what to know about exfoliative dermatitis, including how to get the right treatment to avoid potential complications.
Exfoliative dermatitis happens as a
These triggers lead your skin cells to turn over, or die and shed, too quickly. This rapid turnover of skin cells then causes significant sloughing, or peeling and scaling, of the skin.
While certain skin conditions, reactions to medication, and some diseases can all cause exfoliative dermatitis, healthcare professionals might not always be able to identify the cause.
You might have a higher chance of developing exfoliative dermatitis if you live with a chronic skin condition, such as:
Exfoliative dermatitis can happen as a complication of these skin issues, but experts don’t fully understand exactly how this happens. The development of exfoliative dermatitis may relate to how skin cells and white blood cells interact with the immune system, which then produces the major increase in skin cell turnover.
Adverse reactions to a variety of medications can also contribute to massive skin peeling. The reaction may start as a rash before developing into exfoliative dermatitis.
While nearly any medication can, in theory, cause a reaction if you’re sensitive, medications linked to exfoliative dermatitis include:
- sulfa drugs
- penicillin and certain other antibiotics
- phenytoin (Dilantin) and other seizure medications
- blood pressure medications, including calcium channel blockers
- topical medications
- certain NSAIDs
- proton pump inhibitors
Autoimmune disorders and certain types of cancer have also been associated with exfoliative dermatitis.
Common symptoms of exfoliative dermatitis are:
- intensely itchy skin
- scaling, inflammation, and changes in the color of your skin
- flu-like symptoms that often include chills
Skin and nail changes
Exfoliative dermatitis begins in most people with extreme changes in the color and appearance of their skin. For example:
- Your skin might become red, purplish, pink, or light brown. This discoloration spreads over large portions of the body.
- Massive peeling and scaling, often white or yellowish, follows this discoloration and inflammation. Your skin may feel tight, rough, scaly, or warm to the touch. It may also appear glossy.
- The dryness and peeling of your skin can cause severe itching and pain. You might also develop sores that crust over.
- Your nails may take on a dull appearance, thicken, become brittle, and develop ridges.
Persistent exfoliative dermatitis may lead to lasting changes in the color of the affected skin, along with hair loss or changes in the texture and appearance of your nails.
Exfoliative dermatitis may affect your body’s ability to regulate its temperature. As a result, you might experience flu-like symptoms, such as:
- swollen lymph nodes
Widespread skin peeling can also lead to heat loss from your damaged skin.
Most people with exfoliative dermatitis also feel generally ill.
Complications from skin shedding
Possible complications include:
- Low blood volume. This can happen due to loss of fluid through the shed skin.
- Difficulty absorbing essential nutrients. Constant shedding of skin across your body can prevent the absorption of nutrients that help maintain a healthy epidermis, like vitamins A and D.
- Dehydration and protein deficiencies. You lose protein and fluids from the sloughing, so you may need a healthcare professional to help monitor your fluid and electrolyte levels.
- Increased risk of infection and damage to bone and muscle. Your skin provides a barrier that helps protect bone, tissue, and organs against infection and damage. When your skin sheds significantly, it loses some of these abilities.
Severe symptoms of exfoliative dermatitis can cause life-threatening complications, including:
- fluid and electrolyte imbalances
- cardiac failure
In some rare cases, exfoliative dermatitis can be fatal, typically as a result of pneumonia, septicemia, or heart failure.
You may need to receive treatment in the hospital, but your doctor or clinician may also recommend strategies to help treat symptoms at home, such as topical remedies and rest.
Your care team will first work to address dehydration, low blood volume, heat loss, and electrolyte or nutritional deficiencies. They may:
- provide intravenous (IV) fluids and nutrients to treat these complications
- prescribe medications that suppress your immune system to help slow skin shedding
- recommend phototherapy treatments
- prescribe antibiotics to treat early signs of infection
- provide guidance on wound care and dressing to help reduce your risk for infection
Your care team will also offer support with managing any underlying conditions. If you’re taking any medications that could contribute to exfoliative dermatitis, they may help you find alternate treatment options.
Other important goals of exfoliative dermatitis treatment include reducing inflammation and making you more comfortable, so supportive care could involve:
- a lukewarm bath with oatmeal
- plenty of rest
- wet dressings
- oral antihistamines
- medicated creams to help moisturize dry, itchy skin
- steroid medications to treat severe or chronic inflammation and skin flaking
The outlook for exfoliative dermatitis can vary, depending on what’s causing the reaction. A medication allergy, for instance, might prove easier to treat than an unknown cause. Once you stop the medication and get treatment for your symptoms, your skin will generally clear up within a few weeks.
Managing conditions, such as cancer and psoriasis, can also help speed healing.
If your care team can’t find an underlying cause, you could have flare-ups from time to time. That said, healthcare professionals can do a lot to manage your symptoms, even when they don’t know what causes them.
At the end of the day, exfoliative dermatitis is fairly rare. If you do have symptoms of this condition, it’s best to get the right diagnosis from a healthcare professional so that they can help you identify potential triggers.