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Exfoliative dermatitis, also known as erythroderma, is an uncommon but serious skin disorder that family physicians must be able to recognize and treat appropriately. Although the etiology is often unknown, exfoliative dermatitis may be the result of a drug reaction or an underlying malignancy. The approach to treatment should include discontinuation of any potentially causative medications and a search for any underlying malignancy. One of the most common malignancies associated with exfoliative dermatitis is cutaneous T-cell lymphoma, which may not manifest for months or even years after the onset of the skin condition. Hospitalization is usually necessary for initial evaluation and treatment. In the hospital, special attention must be given to maintaining temperature control, replacing lost fluids and electrolytes, and preventing and treating infection. The long-term prognosis is good in patients with drug-induced disease, although the course tends to be remitting and relapsing in idiopathic cases. The prognosis of cases associated with malignancy typically depends on the outcome of the underlying malignancy.
Exfoliative dermatitis is a disease process in which most, and sometimes all, of the skin is involved in erythematous inflammation resuiting in massive scaling.' A variety of diseases and other exogenous factors may cause exfoliative dermatitis. Unfortunately, the clinical picture does not contribute to an understanding of the underlying cause. Therefore, it is important to identify and treat any underlying disease whenever possible and to remove any contributing external factors.2
Incidence
Most published studies of exfoliative dermatitis have been retrospective and thus do not address the issue of overall incidence. Exfoliative dermatitis accounts for about 1 percent of all hospital admissions for dermatologic conditions.3
Although the disease affects both men and women, it is more common in men, with an average male-to-female ratio of 2.3:1. The average age at onset is 55 years, although exfoliative dermatitis may occur at any time.2
Pathogenesis
Exfoliative dermatitis is the result of a dramatic increase in the epidermal turnover rate. In patients with this disorder, the mitotic rate and the absolute number of germinative skin cells are higher than normal. Moreover, the time necessary for cells to mature and travel through the epidermis is decreased. This compressed maturation process results in an overall greater loss of epidermal material, which is manifested clinically as severe scaling...