Page 60 - LECTURE NOTES
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Possible Etiology of Exfoliative Dermatitis in Adults
Undetermined or unclassified 23%
Psoriasis 23%
Atopic dermatitis, eczema 16%
Drug allergy 15%
Lymphoma, leukemia 11%
Allergic contact dermatitis 5%
Seborrheic dermatitis 5%
Stasis dermatitis with “id” reaction 3%
Pityriasis rubra pilaris 2%
Pemphigus foliaceus 1%
Physical examination
Appearance of Patient frightened, red, “toxic.” Skin is red, thickened, and scaly.
Dermatitis is uniform involving the entire body Surface except for pityriasis rubra
pilaris, where EES spares sharply defined areas of normal skin. Thickening leads to
exaggerated skin folds; scaling may be fine and branny, and may be barely
perceptible or large, up to 5 cm, and lamellar.
Palms and Soles Usually involved, with massive hyperkeratosis and deep fissures in
pityriasisrubra pilaris, Sézary’s syndrome, and psoriasis.
Hair - Thinning of hair, even alopecia, except for EES arising in eczema or psoriasis.
Nails - Onycholysis, shedding of nails.
General Examination Lymph nodes generalized, rubbery, and usually small; enlarged
in Sézary’s syndrome. Edema of lower legs and ankles.
Diagnosis
Diagnosis is not easy, and the history of the preexisting dermatosis may be the only
clue. Also, pathognomonic signs and symptoms of the preexisting dermatosis may
help, e.g., dusky-red color in psoriasis and yellowish-red in pityriasis rubra pilaris;
typical nail changes of psoriasis; lichenification, erosions, and excoriations in atopic
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