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Exfoliative Dermatitis Medication

  • Author: David Vearrier, MD, MPH; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
 
Updated: Apr 11, 2016
 

Medication Summary

Treatment of the underlying illness is key since exfoliative dermatitis resists treatment until the basic disease is treated. Cyclosporine has been reported to be effective,[10]  as has etanercept.[11]

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Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli. They also are used to treat idiopathic and acquired autoimmune disorders.

Prednisone (Deltasone, Orasone, Meticorten)

 

Prednisone is a glucocorticoid that readily is absorbed from the GI tract. It is used primarily for anti-inflammatory effects in disorders of many organ systems.

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Antihistamines

Class Summary

These agents are used to treat minor allergic reactions and anaphylaxis. They are used for relief of pruritus.

Diphenhydramine (Benadryl, Benylin)

 

Diphenhydramine is for symptomatic relief of symptoms caused by the release of histamine in allergic reactions. It may control itching by blocking the effects of endogenously released histamine.

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Immunosuppressives

Class Summary

These agents interfere in the immune processes that promote inflammation. They are used to relieve chronic severe dermatitis.[10]

Cyclosporine (Neoral, Sandimmune, Gengraf)

 

Cyclosporine has been demonstrated to cause remission in some patients. It has improved the overall prognosis of exfoliative dermatitis.

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Antirheumatic, Disease Modifying

Class Summary

These agents modulate inflammatory and immune responses.

Etanercept (Enbrel)

 

Etanercept is a soluble p75 TNF receptor fusion protein (sTNFR-Ig). It inhibits TNF binding to cell surface receptors, which, in turn, decreases inflammatory and immune responses. It has been reported to be effective. There is no current FDA approval/indication for the use of this drug with exfoliative dermatitis.

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Contributor Information and Disclosures
Author

David Vearrier, MD, MPH Assistant Professor, Division of Medical Toxicology, Department of Emergency Medicine, Drexel University College of Medicine

David Vearrier, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

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

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

Disclosure: Nothing to disclose.

Additional Contributors

Mark Louden, MD Assistant Professor of Clinical Medicine, Division of Emergency Medicine, Department of Medicine, University of Miami, Leonard M Miller School of Medicine

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

Disclosure: Nothing to disclose.

Mark P Eid, MD Founder and Director, Virginia Dermatology and Skin Surgery Center

Mark P Eid, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, Pennsylvania Academy of Dermatology

Disclosure: Nothing to disclose.

Mary V Kaldas, MD Resident Physician in Anatomic Pathology, National Institutes of Health

Disclosure: Nothing to disclose.

Acknowledgements

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

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.

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.

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.

Therese I Mendenhall, DO  Resident Physician, Department of Emergency Medicine, University of Arkansas for Medical Sciences College of Medicine

Disclosure: Nothing to disclose.

Jonathan R Pilcher, MD  Resident Physician, Department of Emergency Medicine, University of Arkansas for Medical Sciences College of Medicine

Disclosure: Nothing to disclose.

Selwyn Waterton, MD Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Health Sciences Center

Disclosure: Nothing to disclose.

References
  1. Sterry W, Steinhoff M. Erythroderma. Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Elsevier Limited; 2012. 171-81.

  2. Salami TA, Enahoro Oziegbe O, Omeife H. Exfoliative dermatitis: patterns of clinical presentation in a tropical rural and suburban dermatology practice in Nigeria. Int J Dermatol. 2012 Sep. 51(9):1086-9. [Medline].

  3. Kanthraj GR, Srinivas CR, Devi PU, Ganasoundari A, Shenoi SD, Deshmukh RP, et al. Quantitative estimation and recommendations for supplementation of protein lost through scaling in exfoliative dermatitis. Int J Dermatol. 1999 Feb. 38 (2):91-5. [Medline].

  4. Mahajan VK, Singh R, Mehta KS, Chauhan PS, Sharma S, Gupta M, et al. Idiopathic hypereosinophilic syndrome: a rare cause of erythroderma. J Dermatol Case Rep. 2014 Dec 31. 8 (4):108-14. [Medline].

  5. Bolognia JL, Schaffer JV, Duncan KO, Ko CJ. Erythroderma. Dermatology Essentials. Philadelphia, Pa: Elsevier Saunders; 2014. 76-83.

  6. Zhang JC, Sun YT. Efavirenz-induced exfoliative dermatitis. Scand J Infect Dis. 2012 Jun 20. [Medline].

  7. Ipek Y, Hulya D, Melih A. Disseminated exfoliative dermatitis associated with all-transretinoic Acid in the treatment of acute promyelocytic leukemia. Case Report Med. 2012. 2012:236174. [Medline]. [Full Text].

  8. Brănişteanu DE, Voicu CM, Creţu A, Dimitriu A, Luca MC, Sălăvăstru CM. Adverse reactions of biological therapy for psoriasis. Rev Med Chir Soc Med Nat Iasi. 2015 Jan-Mar. 119 (1):38-44. [Medline].

  9. Shim TN, Berth-Jones J. Erythroderma. Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, Pa: Elsevier Saunders; 2013. 234-38.

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

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

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Exfoliative dermatitis diffuse skin involvement
Table 1. Clinical Clues to Causes of Exfoliative Dermatitis in Adults
Underlying DiseaseHistoryExamination
Psoriasis (common)



 



  • Medical history or family history of psoriasis
  • Withdrawal of corticosteroids, methotrexate, or cyclosporine
  • Face is spared
  • Nail pitting, translucent yellow-red nailbed discoloration, onycholysis
  • Inflammatory arthritis
Atopic dermatitis (common)
  • Past medical history or family history of atopy such as eczema, allergic rhinitis, or asthma
  • Severe pruritus
  • Cataracts
  • Flexural skin most severely affected
  • Lichenification
  • Prurigo nodularis
Drug reactions (common)
  • Recent history of morbilliform or scarlatiniform exanthem
  • No past history of skin disease
  • Medication history includes one of implicated drugs
  • Facial edema
  • Purpura in dependent areas
Idiopathic (common)
  • Elderly men
  • Severe pruritus
  • Chronic and relapsing
  • Palmoplantar keratoderma
  • Dermatopathic lymphadenopathy
Cutaneous T-cell lymphoma



(less common)



  • Intense pruritus
  • Reddish-purple hue
  • Painful, fissured keratoderma
  • Alopecia
  • Leonine facies
Pityriasis rubra pilaris 



(less common)



  • Exacerbated by sun exposure
  • Cephalocaudal progression
  • Salmon hue
  • Sharply demarcated islands of sparing ("nappes claires")
  • Waxy keratoderma
  • Perifollicular keratotic papules
Contact and stasis dermatitis with autosensitization



(less common)



  • History of localized rash
  • Distribution of initial lesions
  • Occupational exposures, hobbies
  • Oral medications (systemic contact dermatitis)
 
Paraneoplastic erythroderma 



(less common)



  • History of malignancy or lymphoproliferative disorder
  • Fine scale
  • Hyperpigmentation
  • Cachexia
Table 2. Medications Associated With Exfoliative Dermatitis
CommonUncommon
  • Allopurinol
  • Beta-lactam antibiotics
  • Carbamazepine
  • Gold
  • Phenobarbital
  • Phenytoin
  • Sulfasalazine
  • Sulfonamides
  • Zalcitabine
  • ACE-inhibitors
  • Chloroquine
  • Colony-stimulating factors
  • Cytarabine
  • Dapsone
  • Diflunisal
  • Efavirenz[6]
  • Fluindione
  • Hydroxychloroquine
  • Isoniazid
  • Isotretinoin[7]
  • Lithium
  • Minocycline
  • Platinum-based antineoplastics
  • Proton-pump inhibitors
  • Ribavirin
  • Thalidomide
  • Tocilizumab[8]
  • Vancomycin (not "red man syndrome" during infusion)
  
  
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