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Exfoliative Dermatitis

Miss Wichuta Thawinwan 483150042-1Miss Saleela Benjawilaikul 483150187-5

Khon Kaen University

Exfoliative Dermatitis(erythroderma)

Uncommon skin disorder

One of the most severe patterns of cutaneous reaction

The etiology is often unknown, may be the result of a drug reaction or an underlying malignancy

Diagnosis : history and examination

Erythema (single or multiple pruritic patches) involving especially the head, trunk and genital region

Erythema (single or multiple pruritic patches) involving especially the head, trunk and genital region

Erythematous, Pruritic eruption(most of the skin surface)

Erythematous, Pruritic eruption(most of the skin surface)

Scaling(small or large, superficial or deep)*acute processes - large scales*chronic processes - small scales

Scaling(small or large, superficial or deep)*acute processes - large scales*chronic processes - small scales

Clinical Manifestations

Scaling severe metabolic (depending on the intensity and the duration of the scaling)

Cutaneous function as a multiprotective barrier is so disrupted, the body loses heat, water, protein and electrolytes, and renders itself much more vulnerable to infection

Thermoregulatory dysfunction that can cause hypothermia or hyperthermia

- heat loss- loss of normal vasoconstrictive function in the dermis- decreased sensitivity to the shivering reflex- extra cooling that comes from evaporation of the fluids leaking out of the weeping skin

lesions

Clinical Manifestations

Exfoliative Dermatitis involved Heart failure(HF)

Physiologic disruptions is potentially life-threatening Hypothermia

- ventricular flutter- decreased heart rate - hypotension- Increased peripheral blood flow can result in high-output cardiac failure

Hypervolemia can also occur in patients with exfoliative dermatitis, contributing to the likelihood of cardiac failure

Example of Drugs cause Exfoliative Dermatitis

• Acetaminophen• Allopurinol (Zyloprim) • Aminoglycosides • Amiodarone (Cordarone)• Calcium channel blockers • Carbamazepine (Tegretol) • Cephalosporins • Cisplatin (Platinol) • Clotrimazole (Lotrimin)• Isoniazid (Laniazid) • Omeprazole (Prilosec)• Penicillins • Phenytoin (Dilantin)

• Ranitidine (Zantac) • Rifampin (Rifadin, • Streptomycin • Sulfadiazine • Sulfonamides • Sulfonylureas • Terbutaline (Brethine,Bricanyl) • Tetracyclines • Thiazide diuretics • Trimethoprim • Tolbutamide (Orinase) • Vancomycin (Vancocin)

- All drugs should be stopped if possible or changed

- hospitalization is often necessary

- The balance of fluids and electrolytes should be closely monitored, since dehydration or hypervolemia can be problems

- vigilant about possible secondary infection, whether cutaneous, pulmonary or systemic

Treatment

Corticosteroids- 40-60 mg PO daily dose may be increased by 20 mg if no improvement observed in 3-4 d; taper over 2 wk as symptoms resolve

Antihistamines

- 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

Immunosuppressives : Cyclosporine

- 2.5-5 mg/kg/d PO in divided doses

Treatment

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