exfoliative dermatitis afp20120201p271-uf1

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]