Patient Case: Exfoliative Dermatitis
A 55-year-old man presents with a two-month history of progressively worsening red, scaly skin that covers most of his body. He reports severe itching, burning, and peeling of the skin, along with episodes of chills and fatigue. The rash initially started on his legs but gradually spread to his trunk, arms, and face. He has also noticed increased hair shedding and thickened, brittle nails.
His medical history includes long-term psoriasis, for which he had been using a high-potency topical corticosteroid. He denies any recent medication changes, infections, or new skincare products.
On examination, nearly 90% of his body surface is covered in diffuse erythema, scaling, and desquamation (skin peeling). His skin feels warm, and there is pitting of the fingernails. No mucosal involvement or signs of infection are noted. His vital signs reveal a mild tachycardia and low-grade fever. A clinical diagnosis of exfoliative dermatitis (erythroderma) is made, likely secondary to psoriasis and prolonged corticosteroid use.
He is admitted for fluid and electrolyte management, given emollients and topical corticosteroids under medical supervision, and started on systemic therapy to address the underlying cause.
a) Atopic dermatitis
b) Seborrheic dermatitis
c) Exfoliative dermatitis (erythroderma)
d) Allergic contact dermatitis
a) Long-term use of high-potency topical corticosteroids
b) Fungal skin infection
c) Exposure to harsh chemicals
d) Deficiency of essential fatty acids
a) Immediate initiation of systemic corticosteroids
b) Hospital admission for fluid, electrolyte, and skin barrier management
c) Performing a skin biopsy before starting treatment
d) Applying over-the-counter emollients at home and monitoring for improvement
a) Secondary bacterial infections and sepsis
b) Development of acneiform lesions
c) Increased risk of allergic reactions to topical treatments
d) Hyperpigmentation as the primary long-term concern
