What Is Exfoliative Dermatitis?

Written by Janie McQueen
Medically Reviewed by Zilpah Sheikh, MD on August 11, 2025
5 min read

Exfoliative dermatitis is a serious skin condition that causes extreme shedding of the top layers of your skin. It may cover most of your body and lead to so much skin damage that your body can’t keep warm. Dehydration is also a risk due to your skin losing its ability to hold onto moisture.

You need urgent care in the hospital for exfoliative dermatitis. Without it, you could have more problems such as dehydration, infection, or shock. It can be deadly.‌

You might hear your doctor call it “erythroderma.” It’s a skin condition that causes red and peeling skin. The peeling may affect 90% or more of your body. It begins in patches and then spreads all over your body. 

You may notice pain or itching. Your skin may flake off and cause a lot of loss of surface skin. This is called sloughing. It’s a serious health problem.

‌Other symptoms of exfoliative dermatitis are:

  • Lesions that crust over
  • Areas of thickened skin
  • Swollen lymph nodes
  • Fever
  • Malaise
  • Viral or bacterial infections due to weakened skin
  • Trouble with body temperature due to skin loss

You may also have swelling in your arms and legs. Some people notice a fast heart rate as well. Your skin may have an unpleasant odor.

Losing layers of your skin may also cause hydration and nutrition issues. You can become seriously dehydrated without enough skin to keep moisture in your body. You may also have a nutritional imbalance as you lose proteins in your skin.

Treatment for exfoliative dermatitis sometimes involves IV fluids and nutritional support to avoid problems from dehydration and malnutrition.

Many things can cause it, such as:

Medication reaction. Certain antibiotics or barbiturates can trigger an allergic reaction in some people. Some anti-seizure medicines have also been known to cause exfoliative dermatitis.

Skin conditions. Exfoliative dermatitis is a condition that may happen due to other skin issues. It might be related to atopic dermatitis, psoriasis, pityriasis rubra pilaris, or another skin condition.

“A wide variety of drugs may cause exfoliative dermatitis,” says medical dermatologist Caroline Nelson, MD, FAAD. She’s an assistant professor of dermatology at Yale School of Medicine and director of Inpatient Dermatology and Grand Rounds. “However, high frequency culprits include antibiotics, anticonvulsants, antimalarials, allopurinol, lithium, and barbiturates.”

Cancer. Certain cancers such as lymphoma can lead to exfoliative dermatitis.

Unknown origin. There is no clear cause in almost a quarter of cases of exfoliative dermatitis.

‌Your doctor will do an exam and discuss your medical history to figure out the reason for your exfoliative dermatitis. They’ll ask you about any medications you’ve taken recently to see if that’s the cause. 

“Drug reaction is the most classic underlying cause,” Nelson says. Exfoliative dermatitis also can be linked to other conditions, including atopic dermatitis (eczema), psoriasis, cutaneous T-cell lymphoma, and rare genetic disorders such as inherited immunodeficiency syndromes, she notes.‌

Your doctor may also order blood tests for a more complete picture of your health. They might biopsy some of the affected skin and send it to a lab for analysis.

What are the risk factors for exfoliative dermatitis? 

You’re more likely to get exfoliative dermatitis if:

  • You have eczema, psoriasis, or another skin condition linked to exfoliative dermatitis
  • You were assigned male at birth
  • You take certain antibiotics, barbiturates, or anti-seizure drugs associated with exfoliative dermatitis
  • You’ve been exposed to phenytoin, allopurinol, or other chemicals
  • You have lymphoma or another type of cancer

The treatment depends on the cause. If you’re having an allergic reaction, your doctor will likely tell you to stop taking the medication that caused it. ‌

You may need to keep working with your medical team to find a replacement medication. Exfoliative dermatitis caused by an allergic reaction usually starts to clear up within weeks of stopping the medication.

You’ll need to see a specialist if you have an underlying issue such as cancer or a condition such as psoriasis. They’ll come up with a treatment plan for you. Treating the underlying issue can help ease your symptoms. 

Managing the symptoms of exfoliative dermatitis is another important step. This condition can be life-threatening without treatment. Your loss of skin can result in dehydration, body temperature issues, and loss of proteins. 

People who have this condition sometimes need to be hospitalized until the symptoms improve.‌ Treatment to manage symptoms might include:

  • Heated blankets
  • Cool baths
  • Petroleum jelly and gauze dressing to protect the skin
  • IV fluids

Wound care is a critical factor in exfoliative dermatitis. Open sores due to loss of skin can get infected. Keeping your skin clean and bandaged correctly will help lower your chances of getting an infection. Your doctor will give you instructions for wound care that you should follow. 

Call your doctor at once if you notice any new or worsening redness, pain, swelling, or unusual discharge from a wound. You may need antibiotics to treat the infection.

Some people with exfoliative dermatitis need to be hospitalized in a unit specializing in burns. Burn unit staff have lots of experience caring for people with skin loss. It may take weeks for your symptoms to get better.

Exfoliative dermatitis can be life-threatening. Call your doctor right away if you have the symptoms of the condition.

Complications or problems that can happen include:

  • Skin damage can allow fluid and protein loss. This can cause dehydration and hamper your body’s ability to retain enough nutrition.
  • The skin damage can allow bacteria or viruses to enter your body and cause infection.

Exfoliative dermatitis is a serious skin condition that causes the top layers of your skin to peel off. It’s a medical emergency. 

Problems that can happen if you don’t go to urgent care include dehydration or infection, or your body can go into a state of shock. 

Exfoliative dermatitis is diagnosed with a body exam. Your health care provider also will collect information about other medical conditions you may have and drugs you take. They might also want to do a biopsy of a skin sample.

What is the difference between erythroderma and exfoliative dermatitis? 

“Erythroderma refers to erythema (redness of the skin caused by increased blood flow to superficial capillaries) and scaling that involves over 80%-90% of the body surface area,” Nelson says. “The terms erythroderma and exfoliative dermatitis are sometimes used interchangeably. Technically, the term exfoliative dermatitis refers to a clinical phenotype [a characteristic you can see] of erythroderma in which the scale has a ‘peeling’ quality.” 

What drugs cause exfoliative dermatitis? 

Many drugs can cause exfoliative dermatitis, especially antibiotics, anticonvulsants, antimalarials, allopurinol, lithium, and barbiturates.

Is exfoliative dermatitis curable? 

“The answer to this question depends on the underlying cause,” Nelson says. “Exfoliative dermatitis due to a drug reaction, for example, may be curable with withdrawal of the offending drug and, when appropriate, treatment to control the immune system activation. In contrast, exfoliative dermatitis due to chronic inflammatory disorders such as dermatitis and psoriasis is not considered curable but can be treated with increasingly effective and targeted therapies.”