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Erythroderma (Generalized Exfoliative Dermatitis): Treatment & Medication
Updated: Aug 24, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
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Treatment
Medical Care
Patients presenting acutely with exfoliative dermatitis (ED) often require admission for inpatient management because their total body functions (including intake and output) can require monitoring. Hospital admission should be seriously considered in pediatric patients who present with erythroderma and fever because this presentation is a predictor of hypotension and even toxic shock syndrome. The principle of management is to maintain skin moisture, avoid scratching, avoid precipitating factors, apply topical steroids, and treat the underlying cause and complications. exfoliative dermatitis commonly resists therapy until the underlying disease is treated (eg, phototherapy, systemic medications in psoriasis). Outcome is unpredictable in idiopathic exfoliative dermatitis. The course is marked by multiple exacerbations, and prolonged glucocorticoid therapy often is needed.
- Discontinue all unnecessary medications. Carefully monitor and control fluid intake, since patients can dehydrate or go into cardiac failure; monitor body temperature, since patients may become hypothermic.
- Apply tap water–wet dressings (made from heavy mesh gauze); change every 2-3 hours. Apply intermediate-strength topical steroids (eg, triamcinolone cream 0.025-0.5%) beneath wet dressings. Suggest a tepid bath (may be comforting) once or more daily between dressing changes. Reduce frequency of dressings and gradually introduce emollients between dressing applications as exfoliative dermatitis improves.
- Institute systemic antibiotics if signs of secondary infection are observed. Antihistamines help reduce pruritus and provide needed sedation.
- Systemic steroids may be helpful in some cases but should be avoided in suspected cases of psoriasis and staphylococcal scalded skin syndrome.
- Increased capillary permeability occasionally is severe enough to justify plasma infusion.
- Preexisting malnutrition may become more marked and require nutritional intervention in older patients.
Consultations
Consult a dermatologist for all cases of exfoliative dermatitis.
Diet
Ensure adequate nutrition with emphasis on protein intake, since exfoliative dermatitis patients lose a lot of protein through excessive desquamation and show a tendency toward hypoalbuminemia. Alter diet as necessary if ingestion of a certain food group is suspected as the etiology of exfoliative dermatitis.
Activity
As tolerated
Medication
Topical steroids are the primary category of medications used to treat exfoliative dermatitis (ED). A sedative antihistamine may be a useful adjunct for pruritic patients, since it helps patients to sleep at night, thus limiting nocturnal scratching and excoriations. Antimicrobial agents often are used if an infection is suspected to be precipitating or complicating exfoliative dermatitis. Other drugs specifically indicated for management of underlying etiology of exfoliative dermatitis may be necessary.
Topical steroids
Exert anti-inflammatory effects by inhibiting early processes (eg, edema, fibrin deposition, capillary dilatation, movement of phagocytes into the area, phagocytic activities). In exfoliative dermatitis, they may inhibit the increased epidermal cell turnover that occurs. Indications include symptomatic relief of inflammation and/or pruritus associated with acute and chronic corticosteroid-responsive disorders.
Triamcinolone (Aristocort)
Medium-potency topical steroid. Use creams and lotions for moist weepy lesions and with intense inflammation (eg, exfoliative dermatitis). Frequency of use in exfoliative dermatitis depends on acute nature of disease and frequency with which wet dressings are changed.
Adult
Apply cream 0.025%, 0.1%, or 0.5% bid/qid
Apply lotion 0.025% or 0.1% bid/qid
Apply ointment 0.1% bid
Pediatric
Apply cream 0.025% qd/bid; 0.1% or 0.5% qd
Apply lotion 0.025% qd/bid; 0.1% qd
Apply ointment 0.1% qd/bid
None reported
Documented hypersensitivity; infections at treatment site or pre-existing skin atrophy
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Adrenal suppression, Cushing syndrome, intracranial hypertension, and growth retardation may occur as a result of systemic absorption of topical corticosteroids; children are more susceptible
Antihistamines
Exert both antipruritic and sedating effects. Used in treating histamine-mediated allergic reactions by competitively inhibiting H1 receptors on effector cells. To varying degrees, they exert sedative effects by crossing the blood-brain barrier and blocking central histaminogenic receptors.
Hydroxyzine (Atarax, Vistaril)
Antagonizes H1 receptors in periphery. May suppress histamine activity in subcortical region of CNS providing antipruritic effects
Adult
25-50 mg PO q4-6h prn
Pediatric
2-3 mg/kg/d PO divided tid/qid prn for pruritus (10 mg/5 mL syr)
May augment sedating effects of alcohol and other CNS depressants; may augment anticholinergic effects of anticholinergic drugs and drugs with anticholinergic effects
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Avoid in hepatic impairment except in exceptional conditions; ECG abnormalities may occur (eg, alteration of T waves); warn patients of expected increase in drowsiness and to avoid tasks requiring alertness or physical dexterity; may exacerbate crises in porphyric patients
More on Erythroderma (Generalized Exfoliative Dermatitis) |
| Overview: Erythroderma (Generalized Exfoliative Dermatitis) |
| Differential Diagnoses & Workup: Erythroderma (Generalized Exfoliative Dermatitis) |
Treatment & Medication: Erythroderma (Generalized Exfoliative Dermatitis) |
| Follow-up: Erythroderma (Generalized Exfoliative Dermatitis) |
| Multimedia: Erythroderma (Generalized Exfoliative Dermatitis) |
| References |
| Further Reading |
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References
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Wong KS, Wong SN, Tham SN, Giam YC. Generalised exfoliative dermatitis--a clinical study of 108 patients. Ann Acad Med Singapore. Oct 1988;17(4):520-3. [Medline].
Keywords
exfoliative erythroderma, ED, erythematous dermatitis, generalized exfoliative dermatitis, red man syndrome, idiopathic ED, idiopathic exfoliative dermatitis, erythrodermatitis
Treatment & Medication: Erythroderma (Generalized Exfoliative Dermatitis)