Exfoliative dermatitis

Exfoliative dermatitis is a skin manifestation that can affect different areas of the body and face, with the appearance of very noticeable lesions, similar to skin burns. According to the ICD-10, the tenth version of the International Classification of Diseases, it may be a pathology in itself, or it may be a symptom of some underlying disease. It is a source of considerable discomfort and can lead to complications, for example infections. For this reason it should never be neglected, but it is necessary to undergo a medical examination.

What is exfoliative dermatitis

Exfoliative dermatitis is quite rare and is not contagious. It is also called erythroderma or burnt skin syndrome, due to the characteristic lesions that form on the skin surface. The disorder can begin more or less rapidly, in several stages. At first, the surface of the skin becomes reddened and shiny, a bit like what happens after exposure to the sun, responsible for the appearance of erythema. However, the situation does not resolve and the skin is covered with scaly and thick, crust-like rashes. These lesions subsequently undergo desquamation and exfoliation. The most superficial layers of the skin die and peel off, leaving areas of reddened and inflamed skin, similar to skin burns. There is also a more severe form, characterized by the appearance on the skin of fluid-filled vesicles.

However, this dermatitis is not characterized by an exclusively cutaneous symptomatology. Flu-like symptoms may also appear, such as fever, generalized malaise, chills due to loss of heat, liquids, minerals and proteins. In addition, the person subject to generalized exfoliative dermatitis sometimes presents itching and swelling of the lymph nodes. In the most serious cases it is possible to be prone to nail and hair loss.

The causes of dermatitis

Usually exfoliative dermatitis is a consequence of some other condition, for example skin or systemic diseases, infections, taking certain drugs.

Among the skin diseases there is, for example, atopic eczema, characterized by intense dryness and itching, or even contact dermatitis, irritative or allergic, due to excessive sensitivity to substances that come into contact with the skin itself.

Autoimmune diseases, such as psoriasis, which is accompanied by dryness, redness and intense itching, can also be responsible for exfoliative dermatitis. Exfoliative dermatitis is a complication of such situations.

Dermatitis can also be the consequence of an allergic reaction to particular drugs, taken as therapy for other disorders, for example barbiturates and sulfonamides. Some antibiotics are also sometimes the cause of the disease.

In addition, at the base of the appearance of exfoliative dermatitis there may be some bacteria, for example Staphylococcus aureus.

Finally, exfoliative dermatitis can be part of the symptomatology of tumor pathologies, for example leukemia or some lymphomas. Mycosis fungoides, or cutaneous lymphoma, can also present with the characteristic lesions of exfoliative dermatitis.

It should be noted that in about a quarter of cases it is not possible to identify a trigger cause of this dermatitis, which therefore occurs as a primary pathology in its own right.

Generalized exfoliative dermatitis

Frequently this skin disease presents as generalized exfoliative dermatitis. Lesions begin at one point, often in the abdomen or chest area. Then the erythema expands more or less rapidly, involving other areas. When it is generalized, exfoliative dermatitis can be a disease in its own right, or it can be linked to serious diseases, for example chronic lymphocytic leukemia or skin lymphoma.

Some cases of generalized exfoliative dermatitis appear in young children, a few weeks old or newborn. At this age, the pathology proper is acute staphylococcal epidermolysis, and the cause is a bacterial infection. Cases of toxin-mediated Staphylococcal Scalded Skin Syndrome have been described, causing the typical symptoms of generalized exfoliative dermatitis. However, these disorders are uncommon.

In newborns, exfoliative dermatitis originates in a particular point of the body, for example around the navel, so large, reddened and deequating lesions appear. Children who show these lesions should be hospitalized immediately. Equation and exfoliation of the upper layers of the skin expose you to risk of dehydration, dangerous for the very young. The therapy is based on the administration of antibiotics, to which other drugs can be added to relieve symptoms such as fever and pain. In addition, products are used to nourish the skin.

Exfoliative dermatitis of the face

In exfoliative dermatitis of the face, rashes affect cheeks, forehead, eyelids, lips and can also appear on the scalp. They also rarely appear on the tongue.

Exfoliative dermatitis of the face can be a consequence of allergies to cosmetic skin care products, it can be a complication of atopic or seborrheic dermatitis, or it can arise following a sunburn.

If it is localized around the mouth, also involving the lips and tongue, it can be confused with perioral dermatitis, a pathology often due to the action of bacteria, fungi and parasites. To identify the appropriate therapy, a thorough medical examination is necessary to confirm the diagnosis.

Exfoliative dermatitis of the hands

In case of exfoliative dermatitis of the hands, the lesions subject to desquamation and exfoliation are located on the palms, between the fingers, near the nails.

It can be linked to contact irritation in people who handle corrosive chemicals without adequate protection, as happens to those who use detergents. Exfoliative dermatitis of the hands can also be the consequence of atopic dermatitis, fungal or bacterial infections and scabies.

It is good that the doctor makes a differential diagnosis with exfoliative keratolysis, a dermatitis of unknown origin characterized by the appearance of patches subject to desquamation. Hyperkeratotic eczema (another disease with unknown causes) can also have the same characteristics as exfoliative dermatitis of the hands, with yellow-brown plaques appearing on the palms of the hands, subject to desquamation.

Possible complications

Exfoliative dermatitis is therefore a dermatological pathology to which appropriate attention must be paid, because it can have important health consequences, not only in children, but also in adults.

First of all, the disorders it causes, such as itching, fever and malaise, obviously affect the quality of life and daily activities, from work to study or sport.

Reddened and obvious injuries are frequently the cause of insecurity in relationships with others and with the partner, leading to drops in self-esteem and a limitation of social life.

In addition, peeling of the skin can expose the body to the risk of a state of shock and favors the onset of serious infections. The risk is higher in case of generalized exfoliative dermatitis, which involves very large skin areas.

Finally, this form of dermatitis should not be neglected because its manifestations can be secondary to other diseases, some chronic such as psoriasis, others even very serious such as leukemia or lymphoma, even cutaneous.

Diagnosis step by step

If you notice the typical symptoms of this dermatitis, it is advisable to contact your doctor immediately for a first visit in order to evaluate signs and symptoms of the problem. At a later time, you can contact a specialist in dermatology. It is necessary to first carry out an accurate anamnesis to frame the symptomatology and understand if it is primary or if the manifestations are secondary to other pathologies.

In fact, if exfoliative dermatitis is due to psoriasis, forms of blood cancer or other diseases, treating the triggering cause also skin lesions should undergo improvement.

The same applies in case of allergic reactions to drugs or contact dermatitis. If the cause is precisely identified, preventing the skin from coming into contact with the substance not tolerated, the situation improves and the development of new lesions is avoided.

If it is not possible to identify the causes, further investigations are necessary: it is advisable to perform a skin biopsy, through the removal of some skin cells at the lesions, which are then examined in the laboratory to exclude lymphomas or other skin cancers. If the doctor deems it appropriate, blood tests and allergy tests are performed.

How to cure exfoliative dermatitis

As mentioned, exfoliative dermatitis, when it is the consequence of other diseases, undergoes an improvement in symptoms when the triggering cause is addressed. Treatments against leukemia, lymphoma, mycosis fungoides act in fact, as a result, also on this skin alteration.

If the causes are allergic or irritative reactions to contact dermatitis, therapy consists of identifying and trying to avoid the responsible substances, including drugs that are not tolerated. In the event that exfoliative dermatitis is due to psoriasis, treatment for this pathology is followed, with immunosuppressive drugs that have the function of attenuating the strong skin inflammation. Against itching, your doctor may suggest antihistamine ointments.

To soften the skin it is important to follow a treatment based on nourishing and emollient creams. Good results are also obtained with natural substances such as oat flour, rice starch, chamomile, borage oil and aloe vera.

In the case of severe forms of exfoliative dermatitis, which expose the person to the risk of infections, dehydration and loss of heat and nutrients, it is necessary to proceed to hospitalization to implement supportive therapies. Antibiotics against infection, drips are needed to replenish liquids, proteins and salts that are lost through the skin and cannot be introduced with food. If these therapies are not effective, it may be necessary to combine corticosteroids, either by mouth or intravenously. The prognosis of exfoliative dermatitis is 2-6 weeks depending on the severity of the problem.