- EES is a serious, at times life-threatening, reaction pattern of the skin characterized by generalized and uniform redness and scaling involving practically the entire skin.
- It is associated with fever, malaise, shivers, and generalized lymphadenopathy, and fever.
- Two stages, acute and chronic, merge one into the other. In the acute and subacute phases, there is rapid onset of generalized vivid red erythema and fine branny scales; the patient feels hot and cold, shivers, and has fever. In chronic EES, the skin thickens, and scaling continues and becomes lamellar.
- There is a loss of scalp and body hair, and the nails become thickened and separated from the nail bed (onycholysis).
- There may be hyperpigmentation or patchy loss of pigment in patients whose normal skin color is brown or black.
- The most frequent preexisting skin disorders are (in order of frequency) psoriasis, atopic dermatitis, adverse cutaneous drug reaction, lymphoma, allergic contact dermatitis, and pityriasis rubra pilaris.
[See “Sézary Syndrome” (Section 20) for a special consideration of this form of EES.]
Usually >50 years; in children, EES usually results from pityriasis rubra pilaris or atopic dermatitis.
Some 50% of patients have history of preexisting dermatosis, which is recognizable only in the acute or subacute stage. Most frequent preexisting skin disorders are (in the order of frequency) psoriasis, atopic dermatitis, adverse cutaneous drug reactions, cutaneous T cell lymphoma, allergic contact dermatitis, and pityriasis rubra pilaris (Table 8-1). Drugs most commonly implicated in EES are shown in Table 8-2. In 20% of patients it is not possible to identify the cause by history or histology.
Table 8-1 Etiology of Exfoliative Dermatitis in Adults |Favorite Table|Download (.pdf)
Table 8-1 Etiology of Exfoliative Dermatitis in Adults
Undetermined or unclassified
Atopic dermatitis, eczema
Allergic contact dermatitis
Stasis dermatitis with “id” reaction
Pityriasis rubra pilaris
Table 8-2 Drugs that Cause Exfoliative Dermatitisa |Favorite Table|Download (.pdf)
Table 8-2 Drugs that Cause Exfoliative Dermatitisa