What is exfoliative dermatitis — patient photos and treatment tips
Photos of patients with skin diseases can shock even a person with a fairly strong psyche. Nevertheless, it is necessary to know the main signs of such diseases, including exfoliative dermatitis, in order to detect them in time and take remedial measures if the need arises.
The clinical picture of exfoliative dermatitis
Exfoliation of the skin is a process when the upper layer of dermis peels off. As a rule, it occurs violently, accompanied by reddening of large areas, itching, blistering and detachment of large fragments of the epidermis.
Mostly, the disease begins with a limited area of the skin, then becomes more and more widespread, moving unrestrictedly on the skin. Symptoms of the disease, in addition to skin pathologies, can cause malaise, fever, and headaches. Such manifestations most often appear in the later stages, when the disease is actively progressing. The disease can occur both acutely and chronically, depending on the reasons that caused it.
Exfoliative dermatitis develops gradually in adults. Early signs are reddening of the skin at a certain site and itching of various severity. Then blisters appear that break open, leaving deep wounds on the skin surface. In this case, the lesion gradually spreads. In severe cases, the epidermis peels off. As a result, the important functions of the skin are disturbed — thermoregulation, protection from damaging factors, as well as the metabolism of proteins in the body.
The most common type of exfoliative dermatitis in adults is sunburn. This is the easiest form of the disease, which usually carries no threat. But even this type of injury can become the entrance gate for an infection.
The most dangerous form of the exfoliative dermatitis is Ritter’s disease. It belongs to the group of infectious diseases of the newborn. Its danger lies in the rapid spread over the surface of the baby’s skin, the rapid development of complications and disorders of the skin. If you do not take medical measures in time, exfoliative dermatitis can lead to the death of the newborn. Its outbreaks are especially dangerous in maternity hospitals or children’s wards of hospitals where newborns are in the same room. This leads to the rapid spread of infection and the death of children.
Possible causes and pathogenesis
There can be many causes of exfoliative dermatitis. The most important ones are:
- Other types of dermatitis in severe form.
- Allergic reaction.
- Radiation exposure.
- Chemical or thermal burns.
Other factors may also be involved in the pathogenesis, including genetic predisposition. The disease most often occurs acutely, cases of chronic course are rare, they are showing the severe violation of the body.
Ritter’s exfoliative dermatitis belongs to the group of infectious diseases. Its reason is the reproduction of Staphylococcus aureus on the skin of the baby. The source of infection may be insufficiently disinfected children’s clothes, as well as parents, medical personnel and other children. That is why the recommendations of pediatricians necessarily require to wash their hands and change into clean clothes to everyone who is in contact with the child.
The disease is manifested by the appearance of large blisters on the skin, which tend to spread and merge. In a baby, thermoregulatory functions are rapidly violated and dehydration develops. If you do not stop the development of infection, it quickly turns into a generalized, and then in a septic form.
In adults, bullous exfoliative dermatitis does not proceed so rapidly but also causes serious complications. The consequences of such a disease can be infectious skin diseases (erysipelas, furuncles, pyoderma), severe scars, the appearance of chronic foci of infection. The development of sepsis in adults is possible in advanced cases.
Severe types of dermatitis
Any weeping kind of dermatitis, accompanied by the formation of blisters on the skin, can turn into a more severe form with active exfoliation. In this case, as a rule, the patient’s condition worsens, and concomitant disturbances of well-being appear.
Exfoliative dermatitis of this etiology is usually difficult. An allergic reaction causes irritation of the skin, which can occur in various forms, including active blistering and flaking. Severe allergy contributes to the fact that in contact with the allergen varying degrees of exfoliation, including necrotic dermatitis develops. This type of damage is accompanied by severe itching, soreness of the skin, which can lead to rupture of small vessels and bleeding.
Radiation dermatitis occurs with strong radiation, and it also proceeds in an exfoliative manner. The most common cause of skin lesions with radiation is sunburn. Usually, it passes easily and without consequences, causing only unpleasant feelings.
Those patients who have been exposed to penetrating radiation in large doses, there are necrotic forms of dermatitis with a detachment of large areas of skin. Depending on the dose received, dermatitis develops in periods from several days to several minutes after irradiation.
Chemical or thermal burns
As well as radiation burns, these skin lesions occur with active exfoliation of its upper layer. Among causes exposure to high temperature, open flame, corrosive chemicals may be. The burn causes complex lesions on the skin, so it is referred to as a separate type of disease, and not to the types of exfoliative dermatitis.
Complications — what will happen if not treated?
Treatment of exfoliative dermatitis in adults is required immediately as soon as a disease is detected. If you do not start the struggle against pathology in time, this process spreads over the surface of the skin. There are two main types of complications — those associated with dermatitis itself and associated with its cause.
Among the complications of dermatitis are thermoregulation disorders due to epidermis detachment. The same process causes a disturbance in the transport of certain proteins, the excretion of sweat, which increases the load on the kidneys. That is why the development of acute kidney failure is possible during the long-term course of the disease.
Infectious complications are the reason why Ritter’s exfoliative dermatitis is among the dangerous diseases of the newborn. Complications of this process can be inflammatory diseases of other organs, such as otitis, pyelonephritis, pneumonia, and phlegmon. The most formidable of them are peritonitis and sepsis, they can be fatal. Such complications are possible not only in children but also in adults.
In cases of allergic and chronic skin diseases, the most frequent complication is the transition of the process to a necrotic form. In the case of radiation, chemical or thermal lesions, the complications of dermatitis do not have time to develop. The signs of the main pathology and protection from adhering infection are much more important.
The diagnosis is made according to the clinical picture. The doctor looks through the characteristic signs of the disease, this is enough to make a preliminary diagnosis. To identify the cause, bacteriological seeding is done. The contents of the bubbles are placed on a nutrient environment and the final results are analyzed.
Blood tests (general and biochemical) provide important information about the general health of the patient. They can be used to track how disturbed the biochemical processes in the body are, what kind of treatment will be most effective, as well as to track changes in the dynamics and evaluate the effectiveness of the treatment.
The condition of the patient, especially in cases of newborns, often leaves no time for a complete diagnosis. The doctor is forced to start treatment immediately, based on the clinical picture, and the survey data is used to confirm or refute his findings and correct the course of treatment. Both local and general agents are used. Hospitalization is required in most adult cases and is strictly required for children.
Among them are the following remedies:
- Antihistamine medications.
- Anti-inflammatory steroids.
- Vitamin drugs and immunomodulators.
Antihistamines for exfoliative dermatitis are prescribed, regardless of whether the allergic component is involved in the pathogenesis. These remedies (Aerius, Suprastin) relieve itching, reduce the severity of irritating influences. Together with them, hormonal anti-inflammatory drugs (Dexamethasone), which stop the development of the inflammatory process, are prescribed. Vitamin preparations are necessary to maintain the normal activity of the immune system.
Antibiotics are prescribed for a wide area of the lesion and in regard to the presence of purulent discharge. To speed up the treatment process and avoid complications, the drugs begin to be administered before the results of the antibiogram are obtained. At the same time, broad-spectrum drugs are used. According to the results of the sensitivity test, the doctor changes or does not change the treatment regimen.
For the treatment of exfoliative dermatitis in children and adults, local remedies are used in extremely small amounts. As a rule, local therapy is limited to the treatment with antiseptic ointments and bandages.
The patient is categorically contraindicated for long water procedures. A shower is taken twice a day, each session lasts 10 minutes. This is due to the fact that prolonged contact with water provokes pain and detachment of the epidermis. The same rule applies to exfoliative dermatitis of newborns. You need to bathe the baby for 10 minutes.
Cosmetics are contraindicated in any form, neither decorative nor caring. The patient should not apply creams to the skin and use soap or shower gel when washing the affected areas. Infants with pemphigus are restricted to baby powder and creams.
Contact with the infection must be completely eliminated, so the patient must lie in a sterile box of the hospital, and medical personnel and visitors are allowed to him only after special treatment and wearing sterile clothing. Touching the patient is possible only with sterile gloves. Bed linen and clothing of the patient must be clean and not have seams.
Ritter’s exfoliative dermatitis in newborns belongs to the group of rapidly progressive diseases. In order to stop the quick developing deterioration of the patient’s condition, and in order to avoid complications, blood, its components or blood substitutes are transferred to him as a therapeutic measure. Salt solutions and glucose solution are injected for detoxification. The amount of transfused plasma may exceed the total volume of the patient’s circulating blood.
Detoxification therapy is also indicated for adults, especially in severe cases. If there is a risk of developing acute kidney failure, hemodialysis or hemosorption is prescribed. When carrying out these procedures, it is important to control the vital functions of the body, such as respiration, heartbeat and blood pressure. Therefore, such manipulations are carried out in the intensive care unit.
Surgical treatment of Ritter’s exfoliative dermatitis in newborns is not used. It is ineffective and does not give any guarantee that the disease will not continue after the procedure. For adults, this method also does not apply.
Exfoliative dermatitis is always a serious skin disease that threatens the patient with not only temporary difficulties but also with serious complications. That is why the early symptoms of such a disease should be referred to a doctor, especially when it comes to children.