exfoliative dermatitis 
definition
is widespread erythema and scaling of the skin.
Causes
pre-existing skin disorders (e.g. atopic dermatitis, contact dermatitis, seborrheic dermatitis, psoriasis, pityriasis rubrapilaris)
use of drugs (e.g. penicillin, sulphonamides, isoniazid, phenytoin, barbiturates)
The cause is unknown but can occur in the context of:
cancer (e.g. lymphoma, mycosis fungoides, leukemia, and rarely adenocarcinomas)
Signs and symptoms
pruritus
malaise
chills
Complications
infection
loss of nutrients
dehydration
heart failure
pathophysiology
Cell division occurs near the basal layer
As cells move toward the periphery, they become well-keratinized.
Normal epidermis has a continual turnover of epithelial cells.
This process requires approximately 10-12 days,
However, common to all conditions that cause exfoliative dermatitis is an increased rateof skin turnover.
Cells subsequently remain in the stratum corneum for another 12-14 days prior to being sloughed.
The pathophysiologic processes resulting in exfoliative dermatitis vary with the underlying disorder responsible for the dermatitis.
Treatment
Correction of electrolyte and thermoregulatory disturbances if present.
initiation of antihistamines and corticosteroids in consultation with a dermatologist.
Fluid resudcitation to replace insensible losses.
supportive care e.g. rehydration.
topical care (e.g. emollients, colloidal oatmeal baths)
Nursing management
encourage the patient to bath in warm water using mild soap, then air dry the skin and gently pat to dry.
usually application of topical steroids cream and ointments is twice a day, spread thinly and sparingly.
prepare the patient for phototherapy because this method uses ultraviolet A or B light waves to promote healing of the skin.
allow the patient to verbalise feelings regarding their skin conditions
encourage the patient to keep the skin clean, dry and well lubricated to reduce skin trauma and risk for infection.
diagnostic procedures
Thin Layer Rapid Use epicutaneos (TRUE) test.
Patch test
Antibiotics
Phototherapy
itching
references
Akhyani M, Ghodsi ZS, Toosi S, Dabbaghian H. Erythoderma: a clinical and etiology study of 97 cases. BMC Dermatol. 2005 May 09;5:5. [PMC free article]