Exfoliative Dermatitis Clinical Presentation

  • Author: Therese I McBride, DO; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Feb 25, 2010
 

History

  • Prior dermatologic illnesses[1]
  • Treatment with new medications
  • Underlying systemic diseases
    • Swelling or adenopathy
    • Recurrent infections
    • Cough or change in bowel or urinary habits
  • Constitutional symptoms of low-grade fever, chills, and malaise (more commonly, patients complain of skin erythema, tightness, and scaling)
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Physical

  • Gynecomastia is a common finding in almost all patients with exfoliative dermatitis of several weeks' duration; it is believed to be secondary to hyperestrogenism, but the precise mechanism is unknown.
  • Additional findings include alopecia, dystrophic nails, and hypopigmentation and/or hyperpigmentation.
  • More than 40% of patients were febrile, with temperatures higher than 38°C; a relative tachycardia also was noted.
  • Firm, rubbery lymphadenopathy, referred to as dermatopathic lymphadenitis, is a common finding.
  • Hepatomegaly was noted in more than 50% of patients in one series, and splenomegaly was noted in approximately 30% of patients, all of whom had lymphoma.
  • Steatorrhea may develop and tends to resolve when exfoliative dermatitis clears.
  • Patients with exfoliative dermatitis have increased cutaneous blood flow, transcutaneous fluid losses, and radiation and convective heat losses.
    • A number of cases of hypothermia have been reported.
    • Fluid shifts increase cardiac output, causing dyspnea, dependent edema, and cardiac failure (possibly) in some patients.
  • Prostate or thyroid glands may be enlarged or nodular.
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Causes

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Contributor Information and Disclosures
Author

Therese I McBride, DO  Assistant Professor, Department of Emergency Medicine, University of Arkansas for Medical Sciences

Therese I McBride, DO is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark Louden, MD, FACEP  Assistant Medical Director, Emergency Department, Duke Raleigh Hospital

Mark Louden, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Mark W Fourre, MD  Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Okoduwa C, Lambert WC, Schwartz RA, Kubeyinje E, Eitokpah A, Sinha S, et al. Erythroderma: review of a potentially life-threatening dermatosis. Indian J Dermatol. 2009;54(1):1-6. [Medline].

  2. Querfeld C, Guitart J, Kuzel TM, Rosen S. Successful treatment of recalcitrant, erythroderma-associated pruritus with etanercept. Arch Dermatol. Dec 2004;140(12):1539-40. [Medline].

  3. Abrahams I, McCarthy JT, Sanders SL. 101 cases of exfoliative dermatitis. Arch Dermatol. Jan 1963;87:96-101. [Medline].

  4. Adams JE, Mali JW, Karger AG, eds. Exfoliative dermatitis (erythroderma). Curr Probl Dermatol. 1972;4.

  5. Bolognia JL, Braverman IM. Skin manifestations of internal disease. In: Harrison's Principles of Internal Medicine. 14th ed. 1998:310-312.

  6. Brady WJ, DeBehnke DJ. Generalized skin disorders. In: Emergency Medicine A Comprehensive Study Guide. 5th ed. 2000:1594-1603.

  7. Freedberg I, Baden H. Dermatology in general medicine. In: Textbook and Atlas. Vol 1. 1987:502.

  8. Karakayli G, Beckham G, Orengo I, Rosen T. Exfoliative dermatitis. Am Fam Physician. Feb 1 1999;59(3):625-30. [Medline].

  9. McKenna JK, Leiferman KM. Dermatologic drug reactions. Immunol Allergy Clin North Am. Aug 2004;24(3):399-423, vi. [Medline].

  10. Morar N, Dlova N, Gupta AK, Naidoo DK, Aboobaker J, Ramdial PK. Erythroderma: a comparison between HIV positive and negative patients. Int J Dermatol. Dec 1999;38(12):895-900. [Medline].

  11. Moschella S, Hurley H. Dermatology. 2nd ed. 1985:543.

  12. Nicolis GD, Helwig EB. Exfoliative dermatitis. A clinicopathologic study of 135 cases. Arch Dermatol. Dec 1973;108(6):788-97. [Medline].

  13. Pruszkowski A, Bodemer C, Fraitag S, Teillac-Hamel D, Amoric JC, de Prost Y. Neonatal and infantile erythrodermas: a retrospective study of 51 patients. Arch Dermatol. Jul 2000;136(7):875-80. [Medline].

  14. Quiceno GA, Cush JJ. Iatrogenic rheumatic syndromes in the elderly. Clin Geriatr Med. Aug 2005;21(3):577-88, vii. [Medline].

  15. Rothe MJ, Bialy TL, Grant-Kels JM. Erythroderma. Dermatol Clin. Jul 2000;18(3):405-15. [Medline].

  16. Shuster S, Brown JB. Gynaecomastia and urinary oestrogens in patients with generalised skin disease. Lancet. Dec 29 1962;2:1358. [Medline].

  17. Sommer S, Henderson CA. Papuloerythroderma of Ofuji responding to treatment with cyclosporin. Clin Exp Dermatol. Jun 2000;25(4):293-5. [Medline].

  18. Voigt GC, Kronthal HL, Crounse RG. Cardiac output in erythrodermic skin disease. Am Heart J. Nov 1966;72(5):615-20. [Medline].

  19. Volcheck GW. Clinical evaluation and management of drug hypersensitivity. Immunol Allergy Clin North Am. Aug 2004;24(3):357-71, v. [Medline].

  20. Wilson HT. Exfoliative dermatitis; its etiology and prognosis. AMA Arch Derm Syphilol. May 1954;69(5):577-88. [Medline].

 
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