Exfoliative Dermatitis Workup
- Author: David Vearrier, MD, MPH; Chief Editor: Barry E Brenner, MD, PhD, FACEP more...
The primary emergency department role in the workup of exfoliative dermatitis is evaluation for systemic derangements as a result of increased insensible fluid loses, changes in fluid distribution, and disturbed thermoregulation. While the underlying cause of some cases of exfoliative dermatitis (eg, drug-induced or generalization of a preexisting dermatitis) may be presumptively identified in the emergency department, identification and/or confirmation of the underlying condition is typically beyond the scope of emergency department care. Therefore, appropriate follow up with a dermatologist for further testing such as skin biopsy and/or lymph node biopsy is critical.
Laboratory studies that may be performed from the emergency department include the following:
- Complete blood count: May demonstrate iron-deficiency anemia or anemia of chronic disease; eosinophilia may be present in cases due to generalization of atopic dermatitis; eosinophilia should also prompt consideration of DRESS (drug rash with eosinophilia and systemic symptoms)/DIHS (drug-induced hypersensitivity) in the differential diagnosis
- Chemistry panel: May demonstrate hypernatremia, prerenal azotemia, or acute renal failure due to insensible fluid losses
- Serum albumin and prealbumin: May be decreased owing to poor nutritional status from protein loss through exfoliation
- Erythrocyte sedimentation rate and serum quantitative C-reactive protein: May demonstrate systemic inflammatory state
- Urinalysis, blood cultures: May be obtained if there is suspicion of infection as a cause of exacerbation of preexisting skin disease (eg, generalization of psoriasis)
- Nasal swab for methicillin-resistant Staphylococcus aureus (MRSA)
In most cases, imaging is not necessary. Chest radiograph and other imaging may obtained if there is suspicion of infection as a cause of exacerbation of preexisting skin disease (eg, generalization of psoriasis) or if high-output cardiac failure is suspected.
No procedures are typically necessary in the emergency department evaluation of exfoliative dermatitis. Peripheral intravenous access by nursing may be difficult to obtain because of overlying skin changes, and ultrasound-guided venous access may be necessary. Inpatient or outpatient follow-up procedures include skin biopsy, which may give histologic clues to the underlying disease. In patients with diffuse lymphadenopathy, follow up includes lymph node biopsy with flow cytometry.
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|Atopic dermatitis (common)|
|Drug reactions (common)|
|Cutaneous T-cell lymphoma|
|Pityriasis rubra pilaris |
|Contact and stasis dermatitis with autosensitization|
|Paraneoplastic erythroderma |