Which physical findings are characteristic of exfoliative dermatitis?

Updated: Jun 22, 2021
  • Author: David Vearrier, MD, MPH; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Vital sign derangements include tachycardia, hyperthermia, and hypothermia. Tachycardia is reflexive in nature, occurring from increased insensible fluid losses and third spacing of fluid. [1] Hyperthermia occurs in 37% of patients and may be due to a hypermetabolic state, while hypothermia occurs in 4% of patients and may be due to excessive heat loss from increased cutaneous blood flow.

Abdominal examination may reveal hepatomegaly (20%), which is most common in drug-induced exfoliative dermatitis. [1] Splenomegaly is uncommon and suggestive of lymphoma.

By virtue of the definition of exfoliative dermatitis, skin examination is significant for erythema and scaling of at least 90% of the skin area. In acute exfoliative dermatitis, erythema may precede exfoliation by 2-6 days and so may not be present when a patient first seeks medical attention. [1] The character of the scale may provide clues to the underlying etiology: fine in atopic dermatitis and dermatophytosis, greasy in seborrheic dermatitis, large exfoliative scale in drug eruptions, and crusted in pemphigus foliaceus.

In chronic exfoliative dermatitis, hyperpigmentation (45%), hypopigmentation or depigmentation (20%), palmoplantar keratoderma (30%), lichenification (one third), nonscarring alopecia (20%), and multiple seborrheic keratoses may be seen. [1] Nail changes may be present in 40% of patients and may include shininess, brittleness, dullness, discoloration, subungual hyperkeratosis, Beau lines, paronychia, splinter hemorrhages, and nail loss. 

Pretibial or pedal edema may be seen in 50% of patients with exfoliative dermatitis. [1] Facial edema may occur with drug-induced exfoliative dermatitis. Diffuse lymphadenopathy is common, seen in approximately 50% of patients, and may be reactive in nature (ie, reactive dermatopathic lymphadenopathy) or may be due to lymphoma.

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