Exfoliative dermatitis is the severe inflammatory condition of the entire skin surface due to reaction to certain drug or due to pre-existing skin condition which leads to this condition.
It is presented by redness and scaling of the skin that begins in the patches and spreads to the whole body. The skin starts shed off, leading to problems like temperature regulation, protein and fluid loss as well as an increased metabolic rate, infection, hair loss, loss of appetite/ nutrients and dehydration. Person with exfoliative dermatitis often needs hospital care or admission to an intensive care burn unit.Exfoliative dermatitis Seen In?
Average age of affection of 40 years; male to female ratio is 2:1
• Idiopathic (15-45%)
• Systemic disease (10-40%) like leukemia, multiple myeloma, Hodgkin disease etc.
• Cutaneous diseases (10-40%) like psoriasis, seborrheic dermatitis, atopic dermatitis, stasis dermatitis, contact dermatitis, lichen planus etc.
• Drug reaction (3-10%)
• Extreme redness of skin
• Crusting lesions
• Thickened skin
• Swollen lymph nodes
• Secondary infection
• Loss of fluids/ dehydration/ protein deficiencies
• Skin damage
• Complete case history
• Physical examination
• Skin biopsy
• Blood test
• Heated blankets
• Cool bath
• Systemic corticosteroids
• Fluid therapy
• Intensive care unit
Prognosis for each patient varies. Drug allergies are easiest to treat where as other associate condition or idiopathic cause need very close care and need to treat as indoor patient.
• Secondary infection
• Dehydration/electrolyte imbalance or both
• Heart failure
• Erythema multiforme
• Kawasaki disease
• Toxic epidermal necrolysis
• Toxic shock syndrome
• Discontinue all unnecessary medications
• Monitor fluid balance and body temperature
• Maintain acceptable room temperature
• Soothing bath
• Compression may also be used
• Lubrication of the infected skin with emollients to prevent skin from drying
• Maintain good nutrition, protein rich diet
• Intense itching, burning when scratches till it become raw.
• Burning stops itching returns.
• Skin dry as paper, flaking, small vesicles.
• Eczema worst on uncovered parts or areas.
• Chilly, weakness, sips cold water.
• Restless, anxious, worried about health, death, security, miserly.
• Worse after midnight, getting wet, cold air or bathing.
• Better by hot bathing, warm room.
• Red itching pimples, honey like sticky liquid oozing with crust over it.
• Infects and scars easily, heels slowly
• Overweight , sweaty, constipated
• Scalp, hairline, behind ears, genitals, back of hands, palms, skin folds.
• Thickened skin, deep cracks in fingers, heels etc, nail thick, grooved.
• Worse at night, menses heat yet chilly.
• Better by cold applications.
• Small itchy blisters with corrosive fluid.
• Skin becomes red, raw and inflamed.
• Eczema on margins of hair bends of joints, behind ears.
• Craves for salt, thirsty.
• Greasy oily hair.
• Skin dry generally.
• Eczema from suppressed emotion, inner grief. Avoids consolation.
• Worse in warmth, salt, seashore and after menses.
• Better in cool weather or bathing.
• Red, raw moist surface, burning itching and oozing after scratching.
• Deep cracks in folds, fingers. Bleed easily, become infected, ulcerations.
• Eruptions of the palms, fingers, bend of joints, behind ears, genitals.
• Itching, scratches until it bleeds, the part become cold after scratching
• Worse in winters, cold air, moving vehicles and at night
• Better in warm air and dryness.
• Intense itching that must be scratched till it bleeds.
• Dirty appearance of skin.
• Eczema behind ears, despair and depression with eczema.
• Infected eczema, offensiveness of all discharges especially of eczema.
• Person anxious and despair of the future, chilly fear of poverty and anguished at night.
• Worse at night, warmth of bed.
• Better from warmth.
• Eczema with blister like eruptions, redness, swelling and intense itching.
• Restless from discomfort and often very irritable and anxious.
• Muscle stiffness which is relieved by warmth and motion.
• Craving for cold milk.
• Better by hot applications.
• Moist, weeping eruptions, foul odor.
• Intense itching, scratches till it bleeds causing burning.
• Dry scaly cracked areas, unhealthy skin pimples easily infected
• Burning hot feet at night.
• Hair margins, face, area of perspiration, feet bends of elbow, knee affected.
• Worse at night, warmth of bed, heat, bathing and wool.
• Better by dry, cool bathing.
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