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Resumen El síndrome de piel escaldada estafilocócica, la escarlatina estafilocócica y el impétigo ampollar son patologías que tienen en común el mecanismo de lesión de la piel por toxinas exfoliativas producidas por estafilococos, su presentación y manifestaciones clínicas son difíciles de diferenciar de otras patologías sistémicas como la enfermedad de Kawasaki, el síndrome de Steven Johnson y diferentes farmacodermias. En los últimos años se ha podido explicar el mecanismo molecular de lesión cutánea, lo que ayudo de manera importante a interpretar y poder realizar un adecuado diagnóstico diferencial entre estas patologías. Los pediatras necesitan múltiples herramientas para llegar a un diagnóstico certero de las noxas que producen lesiones en piel y manifestaciones sistémicas. Una buena anamnesis y el conocimiento de un abanico de diagnósticos diferenciales son importantes para el tratamiento médico.
Abstract Staphylococcal scalded skin syndrome, staphylococcal scarlet fever and bullous impetigo are pathologies that have in common the mechanism of skin injury by exfoliative toxins produced by staphylococci, their presentation and clinical manifestations are difficult to differentiate from other systemic pathologies such as Kawasaki disease, the syndrome of Steven Johnson and drug induced skin diseases. In recent years, it has been possible to explain the molecular mechanism of skin injury, which has helped in an important way to interpret and be able to make an adequate differential diagnosis between these pathologies. Pediatricians need multiple tools to reach an accurate diagnosis of the disease that produce skin lesions and systemic manifestations. A good history and knowledge of a range of differential diagnoses are important for medical management.
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@#INTRODUCTION: Exfoliative dermatitis is a potentially life- threatening inflammatory reaction that poses a significant risk for morbidity and mortality. Several underlying etiologies of this dermatologic condition include pre-existing dermatoses, drugs and malignancy. Although it is a common disease entity, local studies on exfoliative dermatitis published in literature are very limited. OBJECTIVE: The primary objective of this study is to determine the epidemiological profile of patients with exfoliative dermatitis diagnosed at University of Santo Tomas Hospital Dermatology department from January 2008 to December 2012. METHODS: Inpatient and outpatient clinical records of patients diagnosed and treated as exfoliative dermatitis were retrieved. The prevalence, clinical presentation, history of previous dermatoses or use of any drugs/topical medications, family history and accompanying systemic symptoms were reviewed and analyzed. RESULTS: A total of 67 patients were included in this retrospective study. The prevalence among patients with exfoliative dermatitis in this study was computed at 1 per 1000 dermatologic patients. The highest number of cases belonged to the group aged seventy-one to seventy-nine (25.4%) with a mean age of 56.62 years. There was a male predilection (65.7%). Clinical presentation of patients included pruritus, generalized scaling and erythema, accompanied by bipedal edema (41.8%), chills (22.4%), fever (T ≥ 38 °C), lymphadenopathies (6%) and joint pains (4.5%). Several etiologic factors of exfoliative dermatitis recorded were: pre-existing dermatosis (67.2%), idiopathic or undetermined causes (19.4%), drug-induced (10.4%) and malignancy (3%). CONCLUSION: Exfoliative dermatitis is a condition more commonly found in the older age group. Pre-existing dermatoses, drugs and malignancy are etiologic factors. The most common pre-existing dermatosis causing exfoliative dermatitis in this study is psoriasis while the most implicated drug is allopurinol.
Subject(s)
Dermatitis, ExfoliativeABSTRACT
Severe drug eruption is the most common skin drug adverse reaction in clinic. Immune‐mediated adverse drug reactions occur commonly in clinical practice and include mild,self‐limited cutaneous eruptions, IgE‐mediated hypersensitivity, and severe cutaneous adverse drug reactions. Severe cutaneous adverse drug reactions represent an uncommon but potentially life‐threatening form of delayed T cell‐mediated reaction. The spectrum of illness ranges from acute generalized exanthematous pustulosis to drug reaction with eosinophilia with systemic symptoms,to the most severe form of illness,Stevens‐Johnson syndrome and toxic epidermal necrolysis. Drug‐induced exfoliative dermatitis may be one of the manifestations of eosinophilia with systemic symptoms. Typical clinical manifestations,medication history,relevant physical examinations and related auxiliary examinations of patients are helpful to the early diagnosis of the disease. This article introduced in detail the research progress of acute generalized eruptive pustulosis and exfoliative dermatitis eruption.
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Ibuprofen is a NSAID belonging to the class of propionic acid derivatives which is widely used for its analgesic, antipyretic and anti-inflammatory action. Well-known adverse effects of ibuprofen include gastric irritability leading to nausea and vomiting as well as allergic manifestations such as urticaria and skin rashes. Severe ADRs include renal papillary necrosis, SJS/TEN, and thrombotic events leading to myocardial infarction and stroke. Authors present a case of exfoliative dermatitis in an 11-month-old infant possibly due to ibuprofen. An 11-month-old infant was prescribed syrup ibuprofen by a local medical practitioner for unclear reasons. Three days after ibuprofen therapy, the infant developed erythematous, crusting exfoliative lesions predominantly over the face with a few lesions over the lower abdomen. Subsequently, the infant was admitted to Kempegowda Institute of Medical Sciences and Research Center Hospital, Bangalore. A diagnosis of drug-induced exfoliative dermatitis was made after ruling out other causes. Treatment was initiated with intravenous and topical dexamethasone along with saline compressions and amoxicillin + clavulanic acid for secondary bacterial infection as well as topical emollient cream applied over the affected areas. The lesions improved significantly with the above management and the infant recovered enough to be discharged from the hospital after 3 days. The reaction was assessed to be “possible” as per Naranjo and WHO-UMC causality assessment scales, “moderately severe” on modified Hartwig’s severity assessment scale and “not preventable” according to Schumock and Thornton criteria. Severe and serious reactions such as exfoliative dermatitis can be caused by commonly used drugs like ibuprofen.
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Background: Exfoliative dermatitis or erythroderma is a symptom complex characterized by universal desquamation and erythema of the skin in response to various internal or external, known or unknown factors. Largely it is a secondary process and therefore it is mandatory to establish its etiopathology to facilitate the precise management. We attempted to establish the different causes of exfoliative dermatitis. Methods: We reviewed the clinical, laboratory and histopathological findings of 50 patients diagnosed with exfoliative dermatitis. Results: The frequency of exfoliative dermatitis was found to be 0.1 percent. The male-female ratio was 2.5:1 and majority of patients were in their 5th & 6th decade of life (mean age at diagnosis being 45.2 years). The total duration of disease ranged from 2 months to 1 year. The common causative factors were preexisting dermatomes (64%), followed by idiopathic (18%), drug induced (16%) and malignancy (2%). The most common dermatoses were psoriasis (24%) and eczema (24%). Carbamazepine (6%) and antitubercular drugs (6%) were the most frequent drugs which induced exfoliative dermatitis. Apart from scaling with erythema, pruritus and thickening of skin were found in all patients. Anemia was the most common finding (90%), followed by fever (42%), lymphadenopathy (38%) and edema (32%). The best Clinicopathological correlation was found in psoriasis and pemphigus foliaceous. Conclusions: This study outlined that the underlying etiologic factors of exfoliative dermatitis may show geographic variations. In this study preexisting dermatoses was most common cause of exfoliative dermatitis followed by idiopathic causes. Clinical features were identical irrespective of the etiology.
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Eccrine syringofibroadenoma (ESFA) is a rare benign cutaneous adnexal lesion characterized by a hyperplastic epithelium and eccrine ductal differentiation. In the present case, a 73-year-old Korean male presented with symmetrical numerous widespread, pinkish nodules with a cobblestone appearance over both legs for 2 years. He had a history of generalized erythematous scaly patches over his entire body for 20 years. On histopathologic findings, diagnosis of ESFA was confirmed. Our unusual and interesting case emphasizes the first report described one case in which multiple cobblestone like ESFAs arising from long-standing exfoliative dermatitis.
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Aged , Humans , Male , Dermatitis, Exfoliative , Diagnosis , Epithelium , LegABSTRACT
Background Erythroderma is a serious condition in itself, quite apart from hazards associated with the underlying disease, and is sometimes fatal. Prognostic studies are rare in the literature and to date there are no published studies to identify the factors that can determine good prognosis. Objectives The aim of the study is to determine the factors that can prognosticate the good outcome of erythroderma. Methodology Cross sectional study from patients diagnosed to have erythroderma between 2003 and 2007 were analyzed with regard to age, sex, race, underlying medical illness, aetiology, duration of rash before diagnosis of erythroderma, response to topical therapy and prognosis. Results Four variables (aetiology, gender, duration of rash before being diagnosed as erythroderma and response to topical therapy) were associated with good prognosis. These variables were statistically significant from univariate analysis. When these variables were included into the binary logistic model, the study did not have enough evidence to proof that ‘aetiology’ and ‘gender’ can determine good prognosis. Response to topical therapy and shorter duration of rash (equal and less than 120 days) were significant with odds ratio (CI) of 4.11 (1.556, 10.885) and 4.608 (1.903, 11.155) respectively. Conclusion Shorter duration of rash and response to topical therapy are important factors to determine a good prognosis.
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Exfoliative dermatitis to all four first line drugs singly or rarely in combination has been reported. Here we report a rare case of pulmonary tuberculosis with exfoliative dermatitis to all four oral first line antitubercular drugs. (Rifampicin, Isoniazid, Ethambutol, Pyrazinamide). To the best of our knowledge, this is the first such case.
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Graft versus host disease (GVHD) has traditionally been divided into acute GVHD and chronic GVHD based on the period it occurs after transplantation. Chronic cutaneous GVHD has traditionally been classified into the lichenoid and scleroderma-like forms. However, unusual clinical forms have been reported such as dermatomyositis, lupus erythematosus and exfoliative dermatitis. A 35-year-old woman presented with a 2 week history of a pruritic maculopapular rash on the whole body. The rash rapidly progressed to confluent erythematous scaly patches and plaques with micaceous scales and this finally led to a generalized exfoliative dermatitis in a 1 month period. Here we present an unusual case of chronic cutaneous GVHD with the clinical features of exfoliative dermatitis. The histopathologic examination demonstrated the lichenoid features of chronic cutaneous GVHD.
Subject(s)
Adult , Female , Humans , Dermatitis, Exfoliative , Dermatomyositis , Exanthema , Graft vs Host Disease , Transplants , Weights and MeasuresABSTRACT
We describe a 56-year-old Korean man with paraneoplastic pemphigus (PNP) associated with persistent generalized exfoliative dermatitis (GED). He developed multiple scattered flaccid bullae on the erythematous base with scales over his face, upper trunk and extremities, with mucosal involvement for 4 months. Due to myasthenia gravis he also suffered from ptosis, general weakness, and weight loss of 10 kg for a month. A computed tomography and histopathological examination of the chest revealed a mass in the anterior mediastinum which was confirmed as thymoma. During the course of disease, his erythematous patch with crust lesions became confluent, and then GED developed. After total thymectomy, GED waxed and waned for 2-years and eventually disappeared. Herein, we report an interesting case of PNP associated with persistent GED for at least 2 years, even though the patient had been treated with surgery and medication.
Subject(s)
Humans , Middle Aged , Blister , Dermatitis, Exfoliative , Extremities , Mediastinum , Myasthenia Gravis , Pemphigus , Thorax , Thymectomy , Thymoma , Weight Loss , Weights and MeasuresABSTRACT
We report a case of an 82-year-old man who developed exfoliative dermatitis (ED) after receiving radiation therapy for Kaposi's sarcoma of the right foot. One month after irradiation, pruritic erythema appeared within the radiation field and then, evolved into ED. An evaluation to identify the underlying cause discovered no factors likely to cause ED. The skin lesions gradually resolved over a period of one month with the use of narrow band ultraviolet B therapy, oral antihistamines, and low potency topical glucocorticoids. No recurrence has been observed during one year of follow-up. We concluded that this was a rare case of generalized ED occurring after radiation therapy.
Subject(s)
Aged, 80 and over , Humans , Dermatitis, Exfoliative , Erythema , Follow-Up Studies , Foot , Glucocorticoids , Histamine Antagonists , Recurrence , Sarcoma, Kaposi , SkinABSTRACT
Imatinib mesylate (Gleevec(R), formerly known as STI571) is a protein-tyrosine kinase inhibitor that inhibits the bcr-abl tyrosine kinase created by the Philadelphia chromosome abnormality in patients with chronic myeloid leukemia (CML). Between 7 to 21% of the patients treated with imatinib mesylate have been reported to develop adverse cutaneous reactions. However, exfoliative dermatitis related to imatinib mesylate is rare and there is only one previously reported case of this in the Korean literature. We report here on a woman with localized exfoliative dermatitis that developed after administering imatinib mesylate for treating her CML.
Subject(s)
Female , Humans , Benzamides , Dermatitis, Exfoliative , Drug Eruptions , Fusion Proteins, bcr-abl , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Mesylates , Philadelphia Chromosome , Piperazines , Protein-Tyrosine Kinases , Pyrimidines , Imatinib MesylateABSTRACT
BACKGROUND: Erythroderma, a generalized exfoliative dermatitis, is a rare but easily recognized skin condition with the potential for serious outcomes. Various conditions may be associated with the development of erythroderma. OBJECTIVE: The purpose of this study was to evaluate the prevalence, clinical, laboratory, histopathological findings and evolution of erythroderma and classify the various causes of the disease. METHODS: We reviewed medical records, skin biopsy results and clinical photos of 75 patients diagnosed with erythroderma from 1984 to 2006. RESULTS: The male-female ratio was 2.4:1. The mean age at diagnosis was 57 years. 26 out of 75 patients (34.7%) had a history of drug ingestion and a preexisting dermatosis. Nineteen patients (25.3%) remained undetermined. Four patients (5.3%) had concomitant malignancies. In the dermatosis induced group, 10 patients (38.4%) had psoriasis as a possible causative dermatologic disease. Fever (> or =38degrees C) was seen in 28% of patients. Laboratory abnormalities were seen in the order of leukocytosis, eosinophilia, elevated IgE level (>500 IU/ml), elevated erythrocyte sedimentation rate (ESR), elevated lactate dehydrogenase (LDH). There was a significant difference in the proportion of patients showing complete remission to treatment among the groups. In the group of patients who had a recent history of drug ingestion, 42% of patients showed complete remission, whereas the remaining groups, especially the group with preexisting dermatosis displayed only 8% of cases resulting in complete remission (p<0.05). CONCLUSION: In our view, drug use or pre-existing dermatosis induced erythroderma compose the majority of cases. The differences in response rates among groups may give a more realistic estimation of clinical outcome and provide appropriate guidance to clinicians.
Subject(s)
Humans , Biopsy , Blood Sedimentation , Dermatitis, Exfoliative , Eating , Eosinophilia , Fever , Immunoglobulin E , L-Lactate Dehydrogenase , Leukocytosis , Medical Records , Prevalence , Psoriasis , Skin , Skin DiseasesABSTRACT
La eritrodermia es una enfermedad inflamatoria cutánea generalizada. Generalmente se presenta en la edad media de la vida y en la mayoría de los casos es debida a exacerbación de dermatosis preexistentes. Puede asociarse a manifestaciones sistémicas como poliadenopatías, hepatomegalia, eritrosedimentación acelerada, leucocitosis y/o eosinofilia, entre otros. Con el fin de conocer la incidencia y la etiología de esta patología en nuestro hospital realizamos un estudio retrospectivo y observacional sobre 3160 historias clínicas de pacientes internados en el servicio de clínica médica. Detectamos 25 casos de eritrodermia lo cual implica una incidencia del 0.79%. La edad media de presentación fue 48 años. La etiología más frecuente fue la secundaria a medicamentos, siendo los β lactámicos los más involucrados. La alteración sistémica mayormente observada fue la eosinofilia (62%). El comienzo de la enfermedad en la mayoría de los casos fue agudo.
Erythroderma is an inflammatory and generalized skin disorder (more than 90% of the body surface area) accompanied by a variably degree of scaling. Often affects middle ages of life and it is usually caused by the exacerbation of a preexisting dermatoses. It could be associated to systemic manifestations like lymphadenopathy, liver enlargement, leukocytosis and elevated erythrocyte sedimentation. The aim of this study was to determinate the incidence and also the etiology of this pathology in our environment. We made a retrospective and observable study based on the research of 3160 clinic stories of patients that were in the hospital at the Clinical Department. We found that 25 patients were diagnosed with erithroderma (incidence 0.79%). The mean age at diagnosis was 48 years. The most common causative factor was drug reactions been the β lactams the most involved drug. Eosinophilia was the most important systemic manifestation (62%). The onset of erithroderma was usually abrupt and florid.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Dermatitis, Exfoliative/epidemiology , Dermatitis, Exfoliative/etiology , Dermatitis, Exfoliative/complications , Epidemiological MonitoringABSTRACT
STI571 (imatinib mesylate, Gleevec(TM)), a selective inhibitor of the bcr-abl, c-kit, platelet-derived growth factor receptor tyrosine kinases, is a new anticancer drug used for chronic myelogenous leukemia and gastrointestinal stromal tumors. Cutaneous adverse reactions of periorbital edema and exfoliative dermatitis related to STI571 are rare and there have been no previous reports in the Korean literature. We herein report a case of periorbital edema and exfoliative dermatitis due to STI571 and discuss the possible mechanism of periorbital edema related to STI571.
Subject(s)
Dermatitis, Exfoliative , Drug Eruptions , Edema , Gastrointestinal Stromal Tumors , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Mesylates , Phosphotransferases , Receptors, Platelet-Derived Growth Factor , Tyrosine , Imatinib MesylateABSTRACT
Exfoliative dermatitis is caused by various etiologic factors including preceding dermatosis, drug-use, malignancy-related reasons and idiopathies. We present an exfoliative dermatitis caused by topical application of the herbal extract, Saururus chinesis baill. Saururus chinesis bail has been used traditionally as a folk remedy for various kinds of dermatoses in Korea. Therefore, the public should be warned of indiscreetly-used, natural, but not purified, herbal products.
Subject(s)
Dermatitis, Exfoliative , Korea , Medicine, Traditional , Saururaceae , Skin DiseasesABSTRACT
A 28-year-old male began working as a degreaser. The solvent used in the degreasing operation was trichloroethylene. Over the next month the man experienced fever, chills, and an erythematous skin rash and itching. At that time he had a marked elevation in his liver enzyme, with cholestasis. Over the next few days the rash persisted then peeled. There was an elevation of Ig E, and a positive patch test reaction to trichloroethylene. His dermatitis and hepatitis were considered to be mediated by a hypersensitivity mechanism.
Subject(s)
Adult , Humans , Male , Chills , Cholestasis , Dermatitis , Dermatitis, Exfoliative , Chemical and Drug Induced Liver Injury , Exanthema , Fever , Hepatitis , Hypersensitivity , Liver , Occupational Exposure , Patch Tests , Pruritus , TrichloroethyleneABSTRACT
Exfoliative dermatitis is characterized by a universal or very extensive obstinate scaling and itching erythroderma. Although the clinical picture is similar in most patients, there are many etiologic factors in exfoliative dermatitis. We report a case of exfoliative dermatitis developed in a 22-year-old male patient who had been taking oral minocycline (100 mg twice daily) for 5 weeks for acne.
Subject(s)
Humans , Male , Young Adult , Acne Vulgaris , Dermatitis, Exfoliative , Minocycline , PruritusABSTRACT
OBJECTIVE:To probe into the drug categories causing high incidence of exfoliative dermatitis,and to explore the methods for the prevention and cure of this disease.METHODS:240 exfoliative dermatitis cases publicly reported in domestic journal between 1998 and 2008 were reviewed retrospectively and analyzed statistically.RESULTS:Among the total 240 cases,144 were male vs.96 female,which was chiefly induced via oral and intravenous routes;a total of 19 drugs categories(133 kinds)were involved,dominating the first 3 places were anti-infective drugs,central nervous system drugs and antipodagric drugs.Allopurinol,carbamazepine and phenobarbital were top three drugs among all kinds of drugs inducing exfoliative dermatitis.15 patients(6.25%)died.Exfoliative dermatitis was chiefly treated using stosstherapy in which a large dose of the corticosteroids combined antihistamine drugs and calcium gluconate were used,meanwhile antibiotic drugs was used as an anti-infective therapy to reduce the death secondary to septicemia.CONCLUSION:It is urgent to tighten monitoring on the use of key drugs in clinical practice to avoid and decrease the incidence of exfoliative dermatitis induced by anti-infective drugs.