eMedicine Specialties > Emergency Medicine > Dermatology

Dermatitis, Exfoliative: Differential Diagnoses & Workup

Author: Therese I McBride, DO, Assistant Professor, Department of Emergency Medicine, University of Arkansas for Medical Sciences
Coauthor(s): Barry E Brenner, MD, PhD, FACEP, Program Director, Department of Emergency Medicine, University Hospitals, Case Medical Center
Contributor Information and Disclosures

Updated: Jan 15, 2008

Differential Diagnoses

Erythema Multiforme
Pediatrics, Kawasaki Disease
Staphylococcal Scalded Skin Syndrome
Toxic Epidermal Necrolysis
Toxic Shock Syndrome

Workup

Laboratory Studies

  • Perform laboratory studies based on clinical suspicion or history that may help to establish the primary cause of exfoliative dermatitis. Other laboratory studies include the following:
    • Evaluation for cardiac failure and renal and intestinal dysfunction
    • CBC with differential, liver enzymes level, creatinine level, and urinalysis
    • Serum albumin level
    • Erythrocyte sedimentation rate (ESR)
  • The most common laboratory abnormalities are anemia, hypoalbuminemia, eosinophilia, and an elevated sedimentation rate.

Imaging Studies

  • Obtain imaging studies based on suspicion of underlying systemic disease or when other causes are excluded.

Procedures

  • Biopsy
    • Perform skin biopsy and lymph node biopsy if significant lymphadenopathy is noted.
    • Histologic findings generally are nonspecific and include hyperkeratosis, parakeratosis, acanthosis of the epidermis, and perivascular infiltrate consisting of histocytes, lymphocytes, and some eosinophils.

More on Dermatitis, Exfoliative

Overview: Dermatitis, Exfoliative
Differential Diagnoses & Workup: Dermatitis, Exfoliative
Treatment & Medication: Dermatitis, Exfoliative
Follow-up: Dermatitis, Exfoliative
References
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References

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

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

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

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

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

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

  8. 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].

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

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

  11. 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].

  12. 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].

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

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

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

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

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

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

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

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Further Reading

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Keywords

exfoliative dermatitis, erythroderma, epidermis, epithelial layer, epithelial cells, scaling eruption, scaly dermatitis

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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, Program Director, Department of 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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

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, Program Director, Department of 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.

 
 
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