Exfoliative dermatitis

Disease Description (Causes and Symptoms)

• Definition: A condition involving erythema and widespread desquamation over the entire body or extensive areas of skin (erythroderma/exfoliative dermatitis). It can generally affect most of the skin over the body (often around 90%) and results in loss of skin barrier function.
• Main causes:
  • Extension of existing skin diseases: psoriasis, atopic dermatitis, seborrheic dermatitis, contact dermatitis, eczema, etc.
  • Drug-induced (penicillin, antibiotics, anticonvulsants, etc.)
  • Associated with malignant diseases: cutaneous lymphoma (e.g., Sézary syndrome), leukemia, and other internal tumors
  • Rarely idiopathic (cause unknown)
• Pathophysiology summary: Widespread inflammation increases the rate of desquamation and epidermal regeneration and disrupts the skin barrier, resulting in fluid and protein loss, impaired temperature regulation, secondary infection, and a systemic inflammatory response.
• Representative symptoms:
  • Generalized erythema and desquamation (scaling), severe itching
  • Fever, chills, weakness
  • Edema and weight loss due to dehydration and hypoalbuminemia
  • Changes in the hair, fingernails, and toenails (thinning and shedding), lymphadenopathy
  • Possible signs of tachycardia and high-output heart failure

Treatment Methods (Standard Treatment · Medications · Procedures/Surgery · Lifestyle Management · Precautions)

• Basic principles: Identify and eliminate the possible cause (discontinue causative medications and treat underlying skin or malignant diseases) → supportive care to relieve symptoms and prevent complications
• In acute or severe cases:
  • Hospitalization (fluid and electrolyte management, temperature management, infection monitoring)
  • Extensive skin disinfection and maintenance of cleanliness, wound care
  • Nutritional management, including intravenous nutrition and protein supplementation when necessary
• Medication treatment:
  • Systemic steroids: May be used short-term depending on the cause (for drug-induced cases and control of severe inflammation)—however, caution is required with long-term use and in cancer-related cases
  • Immunosuppressants/immunomodulators: Cyclosporine, methotrexate, acitretin, etc. (particularly for psoriasis-related cases)
  • Biologics: Targeted treatment when underlying psoriasis is the cause (individualized selection)
  • Antibiotics: Administered according to indications when a secondary bacterial infection is suspected
  • Antihistamines: To relieve itching
  • Topical treatment: Moisturizers (extensive moisturization) and low-potency topical steroids (when necessary)
• Specific treatment:
  • When cutaneous lymphoma (such as Sézary syndrome) is suspected, treatments specifically for hematologic malignancies (photopheresis-like therapy, systemic chemotherapy, etc.)
• Lifestyle management and self-care:
  • Consume sufficient fluids and nutrients, and apply moisturizer frequently
  • Avoid overheating and excessive temperature changes (maintain a cool environment)
  • Do not use irritating soaps or detergents; use gentle skin care
  • Visit a medical institution immediately if signs of wounds or infection (fever, pus, etc.) appear
• Precautions:
  • When the cause is unknown, long-term steroid use may mask a malignant disease, so a specialist must make the decision
  • The risk of infection increases during immunosuppressive treatment → infection prevention and monitoring are necessary

Checklist Before an Outpatient Visit (Including What to Bring · Items to Confirm Before the Visit · Example Questions)

• Items/materials to bring or submit:
  • A list of all medications currently being taken (including prescription drugs, over-the-counter medications, herbal medicines, and dietary supplements)
  • Records of recent temperature, the date symptoms began, and changes in symptoms (bring photographs if available)
  • Diagnostic certificates and test results related to existing skin diseases, blood cancers, or cancer (if available)
  • Recent test results (blood tests, biopsy reports, X-rays, etc.)
• Items to confirm before the visit (what to tell the medical staff in advance):
  • History of starting or stopping new medications (particularly antibiotics, anticonvulsants, etc.)
  • Whether fever, difficulty breathing, or reduced food and fluid intake is present
  • Whether you are pregnant or breastfeeding (this affects medication selection)
• Example questions to prepare to answer yourself during the outpatient visit:
  • When the symptoms began and how quickly they progressed
  • The severity of itching and pain and their impact on sleep
  • Whether you have had similar skin diseases in the past and how you responded to treatment

Examples of General Questions to Ask the Doctor

• What are the possible causes of this condition, and what tests are needed in our case?
• What are the criteria for hospitalization?
• What initial treatment do you recommend for me, and what side effects can be expected?
• How will infectious, nutritional, and electrolyte complications be monitored and prevented?
• If I need to stop taking a medication, what alternative treatment is available?

Examples of Condition-Specific Questions

• The medication I am taking may be the cause. What procedures are used to determine whether it is drug-induced? (For example, monitoring the course after stopping the medication, and when/how medication rechallenge would be performed)
• If a malignant blood disorder such as cutaneous lymphoma (Sézary syndrome, etc.) is suspected, what additional tests will be performed (skin biopsy, hematologic morphological tests, immunophenotyping, etc.)?