Exfoliative Dermatitis: Definition, Causes, Treatments and More

• Exfoliative dermatitis is a rare condition in which the skin turns red and rapidly sheds.
• It can lead to serious complications, including systemic infection and heart failure.
• Exfoliative dermatitis must be treated by a doctor and often requires hospitalization.
• Home remedies used in conjunction with a treatment plan can alleviate its symptoms.

Exfoliative dermatitis is a serious but rare skin disorder most commonly occurring as a drug reaction or as a symptom of another underlying condition.

Exfoliative Dermatitis Defined 

Exfoliative dermatitis is a condition in which skin cell turnover rate rapidly increases. As a result, large areas of skin on the body become red and peel or flake off.

The word exfoliative refers to the symptom of the skin peeling, while dermatitis is a term used in dermatology to denote any disorder of the skin.

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

Symptoms 

The primary symptoms are patches of red skin that 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 or 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 expand to include electrolyte abnormalities, increased metabolic rate leading to a catabolic state, septicemia (blood infection) and heart failure.

Is exfoliative dermatitis contagious?

This skin disease is not contagious. It is usually a symptom of another underlying 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 be difficult to diagnose accurately.

Common causes of this skin condition include drug reactions and underlying diseases such as dermatologic disorders and cancer.

In up to 25% of cases, no identifiable cause for the disorder can be determined. However, in a significant portion of these cases, the patient eventually develops a form of cancer.

Skin diseases

Individuals with pre-existing dermatoses or skin disorders more likely to develop exfoliative dermatitis. These 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 a common cause of exfoliative dermatitis. The initial symptoms of a drug eruption are similar to those of the disorder, eventually progressing to more generalized exfoliative dermatitis.

Theoretically, any drug can trigger a reaction, but the medications most associated with the 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’s syndrome and graft-vs-host syndrome are associated with the condition.

Exfoliative Dermatitis Treatments

Treatments for exfoliative dermatitis fall into three broad categories: those that address the underlying cause, those that address systemic complications and those that 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 use of the medication should be stopped.

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.

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

Antihistamines

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

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 psolaren 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. The 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 of the disorder, 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 the disorder itself, nor any underlying causes, and should be used in conjunction with a doctor-prescribed care regimen.

Oatmeal baths

Available at pharmacies, colloidal oatmeal is used to relieve 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 one cup of colloidal oatmeal into a lukewarm bath and soak for as long as desired. Oatmeal baths can be taken every day. 

Emollients

Topical emollients include any product or ingredient with the property of softening the skin. Examples of emollient products are creams, lotions, ointments and salves. Common skin-softening ingredients in these products include

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

Apply emollients to the skin as frequently as necessary to reduce itching and flaking during the early stages of exfoliative dermatitis. Use 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. The 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 and potentially serious skin disorder. Common causes include drug reactions, pre-existing skin conditions, certain cancers and autoimmune disorders. In many cases, the cause of the disease cannot be determined.

Primary symptoms of this skin disease 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, who performs a differential diagnosis to determine the underlying cause of the disorder. Accordingly, they develop a treatment plan for the disorder and any complications arising from it.

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