Logo Add Your Company Slogan Exfoliative Dermatitis Miss Wichuta Thawinwan Miss Saleela Benjawilaikul Khon Kaen University

Exfoliative Dermatitis (erythroderma)  Uncommon skin disorder  One of the most severe patterns of cutaneous reaction  The etiology is often unknown, may be the result of a drug reaction or an underlying malignancy  Diagnosis : history and examination

 Erythema (single or multiple pruritic patches) involving especially the head, trunk and genital region  Erythema (single or multiple pruritic patches) involving especially the head, trunk and genital region  Erythematous, Pruritic eruption (most of the skin surface)  Erythematous, Pruritic eruption (most of the skin surface)  Scaling(small or large, superficial or deep) *acute processes - large scales *chronic processes - small scales  Scaling(small or large, superficial or deep) *acute processes - large scales *chronic processes - small scales Clinical Manifestations

Scaling  severe metabolic (depending on the intensity and the duration of the scaling)  Cutaneous function as a multiprotective barrier is so disrupted, the body loses heat, water, protein and electrolytes, and renders itself much more vulnerable to infection  Thermoregulatory dysfunction that can cause hypothermia or hyperthermia - heat loss - loss of normal vasoconstrictive function in the dermis - decreased sensitivity to the shivering reflex - extra cooling that comes from evaporation of the fluids leaking out of the weeping skin lesions Clinical Manifestations

Exfoliative Dermatitis involved Heart failure(HF)  Physiologic disruptions is potentially life- threatening  Hypothermia - ventricular flutter - decreased heart rate - hypotension - Increased peripheral blood flow can result in high-output cardiac failure  Hypervolemia can also occur in patients with exfoliative dermatitis, contributing to the likelihood of cardiac failure

Example of Drugs cause Exfoliative Dermatitis Acetaminophen Allopurinol (Zyloprim) Aminoglycosides Amiodarone (Cordarone) Calcium channel blockers Carbamazepine (Tegretol) Cephalosporins Cisplatin (Platinol) Clotrimazole (Lotrimin) Isoniazid (Laniazid) Omeprazole (Prilosec) Penicillins Phenytoin (Dilantin) Ranitidine (Zantac) Rifampin (Rifadin, Streptomycin Sulfadiazine Sulfonamides Sulfonylureas Terbutaline (Brethine,Bricanyl) Tetracyclines Thiazide diuretics Trimethoprim Tolbutamide (Orinase) Vancomycin (Vancocin)

- All drugs should be stopped if possible or changed - hospitalization is often necessary - The balance of fluids and electrolytes should be closely monitored, since dehydration or hypervolemia can be problems - vigilant about possible secondary infection, whether cutaneous, pulmonary or systemic Treatment

Corticosteroids mg PO daily dose may be increased by 20 mg if no improvement observed in 3-4 d; taper over 2 wk as symptoms resolve Antihistamines mg PO q6-8h prn; not to exceed 400 mg/d mg IV/IM q6-8h prn; not to exceed 400 mg/d Immunosuppressives : Cyclosporine mg/kg/d PO in divided doses Treatment

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