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Exfoliative Dermatitis

Exfoliative Dermatitis. Miss Wichuta Thawinwan 483150042-1 Miss Saleela Benjawilaikul 483150187-5 Khon Kaen University. Exfoliative Dermatitis ( erythroderma ). Uncommon skin disorder One of the most severe patterns of cutaneous reaction

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Exfoliative Dermatitis

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  1. Exfoliative Dermatitis Miss Wichuta Thawinwan 483150042-1 Miss Saleela Benjawilaikul 483150187-5 Khon Kaen University

  2. 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

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

  4. 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

  5. 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

  6. 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)

  7. Treatment • 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

  8. Treatment Corticosteroids • 40-60 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 - 25-50 mg PO q6-8h prn; not to exceed 400 mg/d- 10-50 mg IV/IM q6-8h prn; not to exceed 400 mg/d Immunosuppressives : Cyclosporine - 2.5-5 mg/kg/d PO in divided doses

  9. Thank you

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