0071643192.pdf

DERMATOLOGY

EXFOLIATIVE DERMATITIS (ERYTHRODERMA)

SYMPTOMS/EXAM

■ Presence of erythema and scaling involving >90% of skin surface (see
Table 17.1)
■ Systemic complaints of pruritis, chills, and LAD on exam

ETIOLOGY

■ Caused by drugs, chemical agents, underlying systemic or cutaneous dis-
ease; can have abrupt onset when associated with drugs, contact allergen,
or malignancy

DIFFERENTIAL

■ Primary dermatologic disease (psoriasis, atopic dermatitis, seborrheic
dermatitis)
■ Infection (SSSS, dermatophyte, scabies)
■ Drug reaction (most commonly allopurinol, amoxicillin, carbamazepine,
phenobarbital, phenytoin, sulfonamides, or vancomycin)
■ Malignancy (lymphoma)

TREATMENT

■ Emergent dermatology consultation, hospital admission, correct hypother-
mia and hypovolemia, systemic corticosteroids

TABLE 17.1. Primary Lesions

LESION DESCRIPTION

Macule Flat, nonpalpable, circumscribed lesion <5 mm in diameter

Patch Flat, nonpalpable, circumscribed lesion >5 mm in diameter

Papule Palpable, circumscribed lesion <5 mm in diameter, raised above skin surface

Plaque Palpable lesion >5 mm in diameter, raised above skin surface

Nodule Firm lesion arising in subcutaneous tissue <2 cm in diameter

Tumor Firm lesion arising in subcutaneous tissue >2 cm in diameter

Vesicle Raised, fluid-filled, superficial lesion <5 mm in diameter

Bulla Raised, fluid-filled, superficial lesion >5 mm in diameter

Pustule Pus-filled superficial lesion <5 mm in diameter

Abscess Pus-filled lesion arising in subcutaneous tissue >5 mm in diameter

Wheal Evanescent, raised, round, or flat-topped lesion caused by edema

Exfoliative dermatitis is

distinguished from other

desquamating diseases by a

feeling of skin tightness, scaly

skin, and large areas of

involvement.