eMedicine Specialties > Emergency Medicine > Dermatology
Dermatitis, Exfoliative: Treatment & Medication
Updated: Jan 15, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Emergency Department Care
Hospitalize most patients with acute exfoliative dermatitis in the intensive care unit or burn center for supportive care, fluid replacement, laboratory studies, and contact isolation for protection against secondary bacterial and fungal infections. No studies have suggested a better outcome for patients treated in burn centers.
- General measures
- Withdraw implicated medications or treatment of identified underlying infection, disease, or both.
- Protect patient from development of hypothermia.
- Prescribe cool oatmeal baths.
- Advise local moisturizing ointments, lotions, or both.
- Advise a high-protein diet with folic acid supplementation, since protein losses may be increased as much as 30% above normal.
Consultations
Urgent consultation with a dermatologist is recommended.
Medication
Treatment of the underlying illness is key since exfoliative dermatitis resists treatment until the basic disease is treated. Frequent tub baths with emollients are indicated to provide symptomatic relief.
Corticosteroids
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli. Also used to treat idiopathic and acquired autoimmune disorders.
Prednisone (Deltasone, Orasone, Meticorten)
Glucocorticoid that readily is absorbed from GI tract. Used primarily for anti-inflammatory effects in disorders of many organ systems.
Adult
40-60 mg PO qd; daily dose may be increased by 20 mg if no improvement observed in 3-4 d; taper over 2 wk as symptoms resolve
Pediatric
1-2 mg/kg PO; taper over 2 wk as symptoms resolve
Coadministration with estrogens may decrease prednisone clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics
Documented hypersensitivity; viral, connective tissue, fungal, or tubercular skin infection; PUD; hepatic dysfunction; GI disease
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, PUD, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use
Antihistamines
These agents are used to treat minor allergic reactions and anaphylaxis. They are used for relief of pruritus.
Diphenhydramine (Benadryl, Benylin)
For symptomatic relief of symptoms caused by release of histamine in allergic reactions.
May control itching by blocking effects of endogenously released histamine.
Adult
25-50 mg PO q6-8h prn; not to exceed 400 mg/d
10-50 mg IV/IM q6-8h prn; not to exceed 400 mg/d
Pediatric
12.5-25 mg PO tid/qid, or 5 mg/kg/d, or 150 mg/m2/d divided tid/qid; not to exceed 300 mg/d
5 mg/kg/d IV/IM or 150 mg/m2/d, divided qid; not to exceed 300 mg/d
Potentiates effects of CNS depressants; because of alcohol content, do not administer syr dosage form to patients taking medications that can cause disulfiramlike reactions
Documented hypersensitivity; MAOIs
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
May exacerbate angle-closure glaucoma, hyperthyroidism, peptic ulcer, or urinary tract obstruction; xerostomia may occur
Immunosuppressives
These agents interfere in the immune processes that promote inflammation. They are used to relieve chronic severe dermatitis.
Cyclosporine (Neoral, Sandimmune)
Demonstrated to cause remission in some patients. Has improved overall prognosis of exfoliative dermatitis.
Adult
2.5-5 mg/kg/d PO in divided doses; specialized dosing
Pediatric
Administer as in adults
Carbamazepine, phenytoin, isoniazid, rifampin, and phenobarbital may decrease cyclosporine concentrations; azithromycin, itraconazole, nicardipine, ketoconazole, fluconazole, erythromycin, verapamil, grapefruit juice, diltiazem, aminoglycosides, acyclovir, amphotericin B, and clarithromycin may increase cyclosporine toxicity; acute renal failure, rhabdomyolysis, myositis, and myalgias increase when taken concurrently with lovastatin
Documented hypersensitivity; uncontrolled hypertension or malignancies; do not administer concomitantly with PUVA or UV-B radiation in psoriasis since it may increase risk of cancer
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
Evaluate renal and liver functions often by measuring BUN, serum creatinine, serum bilirubin, and liver enzyme levels; may increase risk of infection and lymphoma; reserve IV use only for those who cannot take PO
Antirheumatic, Disease Modifying
These agents modulate inflammatory and immune responses.
Etanercept (Enbrel)
Soluble p75 TNF receptor fusion protein (sTNFR-Ig). Inhibits TNF binding to cell surface receptors, which, in turn, decreases inflammatory and immune responses.
Has been reported to be effective. No current FDA approval/indication for the use of this drug with exfoliative dermatitis.
Adult
25 mg SC 2 times/wk
Pediatric
0.4 mg/kg SC; maximum single dose 25 mg
None reported
Documented hypersensitivity; sepsis; concurrent live vaccination
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Empiric case reports for effectiveness; no current FDA approval/indication for use with exfoliative dermatitis
Serious infections may develop, and the therapy should be discontinued if they occur; possible adverse effects include pain, redness, and swelling at injection site and headaches; rare cases of lupuslike symptoms and heart failure have been reported (discontinue treatment if symptoms develop)
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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Further Reading
Keywords
exfoliative dermatitis, erythroderma, epidermis, epithelial layer, epithelial cells, scaling eruption, scaly dermatitis
