Exfoliative Dermatitis (Erythroderma): Widespread Symptoms and Treatment

Medically reviewed by Casey Gallagher, MD

Exfoliative dermatitis, also called erythroderma, is a rare but severe medical condition in which inflammation, redness, and shedding affect at least 90% of a person's body surface. This condition requires immediate medical intervention to decrease the risk of developing complications that can even lead to death.

This article covers exfoliative dermatitis symptoms, causes, and treatments.

How Exfoliative Dermatitis Looks: Symptom Identification

Symptoms of exfoliative dermatitis include but are not limited to:

• Widespread redness or rash of the skin

• Pruritus or intense itching

• Scaling, peeling, cracking, crusting skin

• Skin color changes

• Naila becoming thicker, brittle, or pitting

• Malaise (feeling ill)

Because there can be a loss of layers of the skin, some people may not be able to regulate their body temperature normally and may experience fever or chills.

Multiple Causes of Exfoliative Dermatitis (and Unknowns)

Exfoliative dermatitis usually develops due to a preexisting underlying medical condition or as a reaction to certain medications. Some of the numerous causes of erythroderma are:

• Atopic dermatitis (eczema)

• Infections such as human immunodeficiency virus (HIV), scabies

• Autoimmune diseases such as lupus, dermatomyositis, psoriasis

• Cancers such as lymphoma and leukemia

• Drug-induced, including commonly prescription drugs such as penicillins, omeprazole, amiodarone, calcium channel blockers, lamotrigine, and Saint-John's-wort

In about 25% to 30% of cases, no known cause can be identified. This is referred to as idiopathic erythroderma.

How Is Exfoliative Dermatitis Diagnosed?

A thorough history and physical examination along with blood work and a skin biopsy (removing a sample of skin for evaluation in a lab) can help your healthcare provider diagnose exfoliative dermatitis.

Treatment for Severe Exfoliative Dermatitis

Severe cases of exfoliative dermatitis will require hospitalization and evaluation. It is crucial to manage and adequately balance fluids and electrolytes, so treatment typically includes intravenous (IV) hydration.

Additional treatment options can include:

• Systemic steroids (those that work throughout the body) to reduce inflammation

• Immunosuppressive medications such as Otrexup (methotrexate) or Azasan (azathioprine)

• PUVA (psoralen plus ultraviolet A) phototherapy (light therapy)
  

Drugs can also cause exfoliative dermatitis. In these cases, it is recommended to identify which medication is causing the condition and stop taking it.

Having a Secondary Skin Condition

One of the skin's main functions is to act as a protective barrier, guarding the body against infection. Any time there is a breakdown of the skin's protective barrier, it leaves a person susceptible to further injury and infection.

Delay in proper identification of symptoms and diagnosis, comorbidities (secondary diseases), and a weakened skin barrier can all lead to a secondary skin infection and even sepsis (infection spreading to the bloodstream). Immediate attention and treatment are required if a secondary skin infection is suspected.

At-Home Care With Exfoliative Dermatitis

Treatment for exfoliative dermatitis depends on many factors, including its severity and complications. Most cases will require hospitalization, but for some, at-home measures may be beneficial. At-home care for exfoliative dermatitis includes:

• Bed rest

• Lukewarm soaks/baths

• Petroleum jelly

• Oral antihistamines

• Drinking fluids
  

Worsening Symptoms: When to Return to Hospital

If symptoms fail to improve or new symptoms develop while at home, it is imperative to return to the hospital for additional medical management. Some concerning signs that warrant a trip to the hospital are:

• Symptoms that are worsening despite treatment

• New or spreading rash

• Fever

• Loss of consciousness

Summary

Exfoliative dermatitis, or erythroderma, is a dermatologic emergency that requires immediate medical attention. This dermatitis consists of inflammation and shedding at least 90% of the body's surface area, leaving affected individuals susceptible to pain, infection, and even sepsis.

There are many causes of exfoliative dermatitis. The prognosis depends on the underlying cause and comorbidities. If you suspect you may have exfoliative dermatitis, seek medical attention immediately to avoid complications.

Read the original article on Verywell Health.