Exfoliative Dermatitis: Definition, Causes, Treatments and More

• Exfoliative dermatitis is usually caused by a severe drug reaction or by a disease
• This skin disorder can range from mild to severe, and involves the skin turning red and peeling from the body
• Exfoliative dermatitis should be treated by a doctor to address the disorder and to rule out any underlying conditions
• Home remedies used in conjunction with a treatment plan can alleviate symptoms

Exfoliative dermatitis is a rare skin disorder that most commonly occurs due to an adverse drug reaction or as a symptom of an underlying condition. It involves the skin turning red, blistering and eventually sloughing off. While in some cases exfoliative dermatitis can be mild and easily resolved with medication, in other cases, symptoms can be severe.

Exfoliative Dermatitis Defined 

Exfoliative dermatitis is a disorder of the skin cells; skin cell turnover rate rapidly increases and as a result, large areas of skin on the body peel off.

Exfoliative refers to the symptom of the skin peeling; dermatitis is a dermatology term to denote any disorder of the skin.

Also known as erythroderma or red man syndrome, exfoliative dermatitis can occur in both men and women of any age. However, it is more common in men, and the average age of onset is 55. In rare cases, if not adequately treated it can lead to life-threatening complications.

Symptoms 

The primary symptom is the development of patches of red skin. In severe cases, these patches gradually spread over days or weeks to cover approximately 90% of the body. The skin then begins to peel and shed.

Other symptoms include pruritus (itchiness) and flu-like symptoms including fever, chills and general malaise. The nails often become thicker and develop ridges. The lymph nodes may swell (lymphadenopathy), as may the feet and ankles. In most cases, the palms, soles of the feet and area around the nose remain unaffected.

As a consequence of rapid exfoliation, the absence of healthy skin on the body causes further complications. Individuals may experience the symptoms of low blood volume (hypovolemia) and abnormal thermoregulation, meaning that the body cannot maintain a healthy temperature. Laboratory testing may reveal eosinophilia and mild anemia, among other conditions.

Without treatment at this stage, exfoliative dermatitis can become life-threatening. Dehydration, protein deficiencies and infection may occur as the skin barrier function becomes compromised. In severe cases, symptoms progress to include electrolyte abnormalities, increased metabolic rate leading to a catabolic state, septicemia (blood infection) and heart failure.

Is exfoliative dermatitis contagious?

No, it is not contagious. It is usually due to a drug reaction or is a symptom of an undiagnosed medical condition, the majority of which cannot be spread person to person.

Causes of Exfoliative Dermatitis

Exfoliative dermatitis has a wide range of possible causes and can therefore be difficult to diagnose accurately.

Common causes include drug reactions and underlying diseases such as dermatologic disorders and certain lymphomas. However, in up to 25% of cases, no identifiable cause can be determined.

Skin diseases

Individuals with systemic dermatoses or skin disorders are more likely to develop exfoliative dermatitis. Some studies indicate that psoriasis may account for up to 50% of all cases. 

Other disorders include

• Atopic dermatitis
• Candidiasis
• Contact dermatitis
• Crusted scabies
• Eczema
• Ichthyosis
• Lichen planus
• Pemphigus
• Pityriasis rubra pilaris
• Psoriasis
• Seborrheic dermatitis

Drug reactions

Drug reactions are one of the most common causes of exfoliative dermatitis. A drug eruption may start as a rash but eventually progress to more generalized exfoliative dermatitis.

Theoretically, any drug can trigger a reaction, but the medications most associated with this disorder are:

• Allopurinol
• Antiepileptic medications
• Barbiturates
• Blood pressure medications
• Calcium channel blockers
• Carbamazepine
• Isoniazid
• Penicillin
• Phenytoin
• Sulfonamides

Other disorders

Individuals with autoimmune diseases have an increased risk of developing exfoliative dermatitis. Hepatitis, AIDS, Omenn syndrome and graft-vs-host syndrome are associated with this condition. Additionally, in about 1% of cases exfoliative dermatitis can be an early symptom of Sézary syndrome or mycosis fungoides, two rare cutaneous T-cell lymphomas, a type of cancer.

Exfoliative Dermatitis Treatments

Treatments for exfoliative dermatitis fall into three broad categories. They either address the underlying cause, treat systemic complications or alleviate the surface-level symptoms of itching and peeling.

If the cause is determined to be a type of cancer, a doctor will develop an appropriate treatment regimen. If it is a reaction to a medication, the medication should be immediately stopped and appropriate treatment will be prescribed to manage symptoms.

The doctor will perform a physical examination and order a range of diagnostic tests, potentially including evaluation by a nutritional expert, a fluid imbalance assessment and/or a skin biopsy. They will then prescribe medications, therapies and supportive care to address any problems found.

Corticosteroids

Corticosteroids, drugs that mimic steroid hormones naturally produced by the body, lessen swelling, redness and itchiness associated with exfoliative dermatitis.

In mild cases, a doctor may prescribe a low-potency topical steroid such as hydrocortisone. For severe cases, oral corticosteroids such as prednisone are typically prescribed for ten days and then tapered off.

Antihistamines

Oral antihistamines reduce histamine, a compound naturally produced by the body during an allergic or inflammatory reaction. Antihistamines can relieve itchiness and inflammation.

Phototherapy

A type of light therapy called PUVA (psoralen and ultraviolet A) can treat certain underlying causes of exfoliative dermatitis.

PUVA is performed at a hospital or clinic. During a treatment session, the drug psoralen is applied topically or taken orally to sensitize the skin to light. The skin is then exposed to ultraviolet light for a predetermined amount of time; treatment is repeated several times a week until symptoms improve.

Antibiotics

Antibiotics combat infection occurring as a complication from exfoliative dermatitis. The exact medication prescribed depends on the severity and nature of the infection.

Retinoids

If another skin condition such as psoriasis or pityriasis rubra pilaris is the cause, a doctor may prescribe retinoids. However, the exact mechanism by which retinoids address the exfoliative dermatitis is not known.

Home Remedies 

The following treatments can be performed at home and are recommended by doctors to alleviate symptoms of exfoliative dermatitis. They cannot treat any underlying causes and should be used in conjunction with a doctor-prescribed care regimen.

Oatmeal baths

Available at pharmacies, colloidal oatmeal is effective in relieving itching and irritation. It forms a protective film over the skin and helps the skin’s natural protective barrier, the stratum corneum, retain moisture.

To use, pour 1 cup of colloidal oatmeal into a lukewarm bath and soak for as long as desired. You may take an oatmeal bath every day. 

Emollients

Topical emollients include any product or ingredient with skin-softening properties. Examples of emollient products are creams, lotions, ointments and salves. Look for any of the following ingredients in these products to soothe inflammation and irritation:

• Beeswax
• Shea butter
• Lanolin
• Aloe vera
• Glycerin
• Vitamin E
• Squalene
• Mineral oil
• Petrolatum

Apply emollients to the skin as often as necessary to reduce itching and flaking during the early stages of exfoliative dermatitis. Choose hypoallergenic, fragrance-free products to lessen the likelihood of irritation. 

Should You See a Dermatologist? 

If you experience the initial symptoms of exfoliative dermatitis—red, itchy patches of skin rapidly spreading across the body—see a doctor. This disorder is not likely to resolve on its own and, if allowed to progress, can require hospitalization.

Takeaway 

Exfoliative dermatitis, also known as erythroderma, is a rare but potentially serious skin disorder. Common causes include drug reactions, preexisting skin conditions, certain lymphomas and autoimmune disorders. In many cases, the cause cannot be determined.

Primary symptoms are flu-like symptoms and red, itchy patches of skin that gradually spread across the body before they start to scale and flake off. Over time, serious complications, including systemic infection and heart failure can develop.

Exfoliative dermatitis must be treated by a doctor. They will diagnose the underlying cause and develop a treatment plan accordingly. They’ll also monitor you throughout treatment for any complications.

As part of a doctor-prescribed treatment plan, home remedies such as oatmeal baths and emollients can be effective to alleviate symptoms.