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Exfoliative Dermatitis at a Glance
  • Exfoliative dermatitis (ED) is defined as diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface area.
  • Systemic and potentially life-threatening complications include fluid and electrolyte imbalance, thermoregulatory disturbance, fever, tachycardia, high-output failure, hypoalbuminemia, and septicemia.
  • Common underlying etiologies are psoriasis, atopic dermatitis, and other spongiotic dermatoses, drug hypersensitivity reactions, and cutaneous T-cell lymphoma (CTCL). The cause of ED is unknown (idiopathic) in approximately 20% of cases.
  • Diagnostic workup includes a complete history and physical examination, with careful analysis of pertinent clinical clues and dermatohistopathology. Other laboratory workup is often required and determined by clinical clues.
  • Management of ED involves combining symptomatic relief with addressing the underlying etiology and potential systemic complications. Inpatient hospitalization is required in acute cases.
  • Prognosis is variable and depends primarily on the underlying etiology. Drug-induced ED has the best prognosis while malignancy-associated ED has the highest mortality.

Several large studies have reported a widely varied incidence of exfoliative dermatitis (ED) ranging from 0.9 to 71.0 per 100,000 outpatients.14 A male predominance has been described, with a male-to-female ratio of approximately 2:1 to 4:1. Any age group can be affected, and with most studies excluding children, the average age of disease onset varies from 41 to 61. ED is a rare disease in children, and only little epidemiologic data is available for pediatric populations. One study found 17 patients, recorded over a 6-year period, with a mean age of onset of 3.3 years and a male-to-female ratio of 0.89:1.5 ED occurs in all races.6

A preexisting dermatosis plays a role in more than one-half of the cases of ED. Psoriasis is the most common underlying skin disease (almost one-fourth of the cases). In a recent study of severe psoriasis, ED was reported in 87 of 160 cases.7

Establishing the etiology of ED can be challenging since it can be caused by a variety of cutaneous and systemic diseases (Table 23-1). A compilation of 18 published studies1,2,4,6,821 from various countries on ED shows that a preexisting dermatosis is the most frequent cause in adults (52% of ED cases; range, 27%–68%) followed by drug hypersensitivity reactions (15%), and cutaneous T-cell lymphoma (CTCL) or Sézary syndrome (5%). No underlying etiology is identified in approximately 20% of ED cases (range, 7%–33%) and these cases are classified as idiopathic.

Table 23-1 Diseases Associated with Exfoliative Dermatitis

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