Erythroderma (Exfoliative Dermatitis)

Exfoliative dermatitis or otherwise called erythroderma is a skin eruption characterized by constant fast changing of skin that is why it appears to be scaling. This scaling of the skin can be related to drug reactions, systemic disease or other illnesses that has to do with the appearance of such skin problem.

Normally, the skin regenerates in 10 to 12 days. The continuous changing of the cells in the stratum corneum takes 12 to 14 days before it sloughs off. However, in the case of exfoliative dermatitis, more cells slough off in a lesser time. The theory behind this might have an immunologic origin.

The incidence is rampant almost in all races. When it comes to sex groups, males have a double tendency to acquire this compared to women. By the time that individuals reach the age of 40, they are more prone from experiencing exfoliative dermatitis.

Diagnostic Evaluation:

Upon assessment, the patient may have a history of skin diseases already. Drugs that have been taken into the system must be taken into account since there is drug-induced exfoliative dermatitis. Systemic diseases may also account for such occurrence. Systemic diseases such as constant exposure to infections, swelling, low-grade fever, chills. Physical manifestation may start from skin itching, skin redness as well as eventually scaling of the skin.

Diagnosis may come into final part if physicians may conclude that the exfoliative dermatitis is caused by drugs. It is drug-induced if physicians observe a progress of the exfoliative dermatitis if medications are temporarily stopped. Skin-diseases related exfoliative dermatitis may be pointed out if proper history is done.

Signs and Symptoms:

1. Gynecomastia – due to higher levels of estrogens
2. Hair loss
3. Nails are dystrophic or malformed
4. Skin discoloration either hypopigmentation or hyperpigmentation
5. Systemic reaction as evidenced by low-grade fever as well as swelling of lymph nodes
6. Spenomegaly or hepatomegaly due to lymadenopahty
7. Prostate or thyroid glands are enlarged for males

Causative Factors:

1. Systemic diseases – this comprised 10% to 40% of the patients. They may have previous or present illness such as leukemia, carcinomas, Hodgkin disease.
2. Skin diseases – This is equal to systemic diseases. Ten percent to 40% may have psoriasis, atopic dermatitis, contact dermatitis.
3. Drugs – Drug-induced may account three percent to 10% of the cases. People who take codeine, captopril, iodine, allopurinol, phenytoin and other medications may have this.

Medical Management:

1. The physician will base the medical management that will be introduced through: age group the individual belong, the degree of reaction, level of tolerance of the individual in such procedures as well as therapies. Personal opinion is very essential for physicians to consider in order getting the cooperation of the patient.
2. Hospitalization is needed as well as isolation might be needed if the case of exfoliative dermatitis is severe. The course of treatment involves corticosteroids, intravenous fluids due to increase probability of dehydration as well as dietary supplements.
3. Pharmacologic management is concentrated to the use of the following drugs: antibiotics that have been tested prior to administration in order to avoid such skin reactions, corticosteroids as well as other anti-inflammatory medications.

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

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