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  5. Exfoliative Dermatitis: Causes, Symptoms, Diagnosis, & Treatment

Have you noticed any sudden inflammation and excessive shedding in your skin after taking a prescription-based medicine? Do you have an underlying skin issue that results in skin inflammation? This type of severe skin inflammation is known as generalized exfoliative dermatitis.

Exfoliative dermatitis, also called erythroderma, occurs due to a reaction from taking prescription-based medications. It can also occur due to a few types of cancer, or an underlying skin issue. Read on to know the causes, symptoms, treatment, and diagnosis of exfoliative dermatitis.

Ayurvedic Doctor’s Opinion

“Exfoliative dermatitis needs quick diagnosis and treatment to avoid complications."
- Dr. Zeel Gandhi, Chief Ayurvedic Doctor at Vedix.

What Is Exfoliative Dermatitis?

Exfoliative dermatitis refers to sudden redness, inflammation, and peeling of the affected skin that appears as large patches on the body. The first term, ‘exfoliative’ signifies the general shedding, or exfoliation of the skin, whereas the latter term ‘dermatitis’ refers to the inflammation or irritation of the skin.

In a few individuals, the skin shedding may appear due to an underlying, persistent health condition, or as a side-effect of taking prescription-based medications. Additionally, the exact cause of the skin condition remains unknown in a few individuals.

There is no known causative agent in at least 25% of individuals afflicted with exfoliative dermatitis. The associative symptoms include scaling and redness of the skin which appear as small patches and gradually spread. The affected skin starts to slough off, which causes issues like fluid and protein loss, imbalance in temperature regulation, and heightened rate of metabolism [1].

Exfoliative dermatitis is a rare and serious condition. The repercussions of this skin condition include heart failure, dehydration, loss of essential nutrients, infections, and in rare cases, fatality.

Men are more susceptible to exfoliative dermatitis than women.

What Does Exfoliative Dermatitis Look Like?

psoriatic skin disease psoriasis vulgaris

As discussed earlier, exfoliative dermatitis is an uncommon yet serious skin condition that leads to reddening and peeling of the affected skin. This shedding may affect more than 90% of the body. The skin condition appears in small patches which gradually begin to spread to the rest of the body [2].

Once afflicted, you may begin to experience itching or pain in the affected area. The skin may flake off and result in major loss of top-layer skin. This condition is known as sloughing and it is considered a serious health issue.

Some of the other signs of exfoliative dermatitis include:

  • Issues with body temperature regulation due to loss of skin
  • Bacterial or viral skin infections due to fragile skin condition
  • Malaise
  • Fever
  • Swollen, protruding lymph nodes
  • Affected areas with thickened skin
  • Lesions with crusts

You may also experience swelling in your legs and arms. A few people may notice an irregular heart rate. Additionally, you may experience an unpleasant skin odor.

What Causes Exfoliative Dermatitis?

The primary cause of exfoliative dermatitis is an abnormality of the skin cells. The skin cells die and slough off rapidly which is known as turning over. This quick turnover results in major loss of skin cells via peeling and scaling. These two processes are also called sloughing.

Some of the causes of exfoliative dermatitis include:

1. Underlying Health & Skin Conditions

Many individuals who experience persistent, chronic skin ailments such as eczema, seborrheic dermatitis, psoriasis, and autoimmune disorders may also suffer from exfoliative dermatitis.

2. Drug Reactions

Harmful reactions to a few specific drugs may also lead to significant skin peeling. Medications that may lead to exfoliative dermatitis include:

  • Topical medications (which is applied externally on the skin)
  • Calcium channel blockers
  • Blood pressure medications
  • Isoniazid
  • Phenytoin and various other seizure drugs
  • Barbiturates
  • Penicillin
  • Sulfa drugs

Please note that any medications may result in exfoliative dermatitis.

3. Other Causes

Specific types of cancer such as lymphoma and leukemia may increase the turnover rate of skin cells [3]. Nearly 25% of exfoliative dermatitis cases are categorized as idiopathic. Idiopathy is a medical term that signifies a condition or disease which has no definitive or known cause.

Important Note:

Exfoliative dermatitis may become potentially life-threatening and may require hospitalization in severe cases. The prognosis (outlook) is based on the primary cause.

In case it occurs due to prescribed medications, the skin condition generally lasts 2-6 weeks after stopping the medication.

Symptoms Of Exfoliative Dermatitis

The signs and symptoms of exfoliative dermatitis include:

1. Skin & Nail Changes

Exfoliative dermatitis appears with sudden reddening of the skin, which gradually spreads over the rest of the body. This skin colour change is called erythroderma. Exfoliative dermatitis and erythroderma are both terms for this skin condition.

After inflammation and reddening of the skin, significant peeling and scaling occur in the affected skin. The affected skin may be scaly and rough in texture. The peeling and dryness of the skin may result in pain and itching. The nails may also turn ridged and thicker in appearance.

2. Flu-Like Symptoms

Individuals with exfoliative dermatitis may also experience flu-like symptoms including chills and fever. This happens when major peeling and scaling of the skin affect the internal body temperature regulation. This may result in heat loss from the affected skin. A common symptom of exfoliative dermatitis is overall fatigue and sickness.

3. Difficulties With Skin Shedding

Individuals with exfoliative dermatitis may also experience a lower blood volume. This happens when a fluid loss takes place through the skin shedding process.

A. Skin shedding may first occur in smaller patches. However, it starts spreading to other parts of the body. Your skin primarily constitutes proteins. The persistent sloughing of skin cells obstructs your body from taking up essential nutrients (like Vitamin A and D) which is crucial for maintaining a functioning epidermis.

B. Additionally, you lose fluids and proteins from the shedding process. Various protein deficiencies and dehydration are some of the complications of skin shedding.

C. Two primary functions of the human skin are to protect the inner organs and provide a defensive barrier to various infections and other external triggers.

D. Due to the significant shedding of skin cells, the skin’s defensive action is obstructed. This lowered defense makes you susceptible to various infections as well as adversely harms the underlying bones and muscles.

4. Severe Symptoms

Some of the potential harmful symptoms of erythroderma may be life-threatening. Individuals who experience complications like cardiac failure, electrolyte and fluid abnormalities, and infection are easily susceptible to the risk of death.

Some of the common reasons for death among individuals with exfoliative dermatitis include heart failure, septicemia, and pneumonia.

How Do You Treat Exfoliative Dermatitis?

woman applying medical cream on burning scar on her hand

A. Ayurveda For Exfoliative Dermatitis

According to the ancient and holistic Ayurvedic science, the majority of skin ailments are categorized as kushtha.

The associated symptoms of eka kushtha like matsyasaklopam (scaling of skin mimicking fish scales), mahavastu (extensive lesions spread all over the body), and aswadanam (lack of sweating) are closely related to erythroderma [4].

As per the traditional ayurvedic texts, eka kushtha is an aggravated tridosha vyadhi. Because of this aggravated dosha, it is recommended to perform sodhana chikitsa in the afflicted individual followed by pathya-apathya along with shamana chikitsha.

B. Medical Treatment For Exfoliative Dermatitis

Exfoliative dermatitis may require medical treatment in the hospital. It is necessary to check and correct any nutritional or electrolyte deficiencies, heat loss, low blood volume, or dehydration under medical supervision. Additionally, your doctor may suggest IV nutrients and fluids to resolve these health issues.

  • Minimizing inflammation and ensuring a soothing and comforting environment are the primary points of any treatment plan.
  • The supportive plan includes oral histamines, adequate rest, and warm baths. Additionally, your doctor may advise medicated external lotions to moisturize your itchy, dry skin.
  • Steroids help treat flaking of the affected skin and resolve chronic or severe inflammation [5].
  • A few individuals may get relief from ultraviolet A rays, photosensitizing agents, psoralen-based treatment, and phototherapy.
  • Medications that help lower the immune response may decrease cell turnover, especially for individuals with severe symptoms.
  • Infections due to exfoliative dermatitis may appear as a severe complication. Antibiotics may help resolve and prevent such potentially serious infections on the skin. For preventing skin infections, it is imperative to be careful while wound dressing.
  • You may be advised to stop taking any prescribed medications which may result in allergic reactions. This will help manage and contain any underlying health or skin issues.

Vedix Tip: Jatyadi taila, arogyavardhini vati, kaishore guggulu, and rasamanikya are potent and effective in treating mandala kushtha, vishphota, vatarakta, sphuthit kushtha, and galita kushtha (skin ailments with suppuration).

How Is Exfoliative Dermatitis Diagnosed?

The blood count of affected individuals may exhibit eosinophilia, white cell count irregularities, and anaemia. Raised eosinophilia may result in suspected lymphoma.

  • Less than 20% of circulating Sezary cells in the skin may indicate Sezary syndrome
  • The level of C-reactive protein may become high or remain unchanged
  • The presence of polyclonal gamma globulins is a common indicator
  • A high level of immunoglobulin E is a typical symptom of idiopathic exfoliative dermatitis

Skin samples for biopsies may be taken from various areas when the primary cause of exfoliative dermatitis is not clear. During histopathology, these samples usually exhibit nonspecific inflammation.

Direct immunofluorescence is greatly helpful when an underlying connective tissue disorder or autoimmune disorder is the primary cause of exfoliative dermatitis.

How Long Does Exfoliative Dermatitis Last?

In most of the cases, the symptoms of exfoliative dermatitis sort out within 2 to 6 weeks post the cessation of the triggering cause. The prognosis is poor for individuals with idiopathic erythroderma.

Chronic symptoms or frequent recurrences need steroid treatment in the long-term.

“Ayurvedic therapies help greatly in controlling the intensity of the chronic cases”, says Dr. Zeel Gandhi, Chief Ayurvedic Doctor at Vedix.

The Last Word

Erythroderma is a medical term that signifies erythema impacting around 90% of the skin surface in affected individuals. Exfoliative dermatitis signifies the skin peeling and exfoliation in erythroderma. The varying degree of skin transformation may hide the primary patch. This may make it difficult to identify and treat the underlying cause of exfoliative dermatitis.

The outlook of exfoliative dermatitis is based on the primary cause. When this is treated or eliminated, then the diagnosis is excellent. If exfoliative dermatitis is caused by an underlying skin disorder like eczema or psoriasis, then it typically resolves with the suggested treatment of the disorder. However, it may reappear at any given time.

Know Your Dosha Now

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