Exfoliative dermatitis: patterns of clinical presentation in a tropical rural and suburban dermatology practice in Nigeria.

BACKGROUND: Exfoliative dermatitis (ED) refers to a skin condition in which the skin is diffusely red and inflamed, with varying degrees and types of scaling. It is a serious medical condition and may require hospitalization.

OBJECTIVES: This study was conducted to establish the demographics, etiology, and clinical outcomes of patients presenting with ED at the dermatology outpatient clinic at Irrua Specialist Teaching Hospital (ISTH), Irrua, Edo State, Nigeria.

METHODS: The study used a retrospective, cross-sectional, descriptive design. The records of all dermatology patients attending the ISTH outpatient clinic were scrutinized for patients in whom ED was diagnosed and managed between March 1, 2004, and November 30, 2010. Relevant records were extracted and details subjected to statistical analysis. Main outcome measures were discharge and death.

RESULTS: A total of 1422 dermatology patients were seen at the dermatology outpatient clinic during the study period. Of these, 39 were diagnosed with ED (hospital prevalence rate: 2.7%). The mean age of the ED patients was 60.0 ± 19.5 years (range: 21-90 years). Patients included 22 men and 17 women, giving a male:female ratio of 1.3:1. Of patients aged <40 years, 70% were HIV-positive, and antiretroviral medications accounted for 5% of cases of ED, whereas 50% of elderly patients had a suspected underlying malignancy.

CONCLUSIONS: Erythroderma is an uncommon dermatologic presentation. Its recognized association with various internal malignancies makes it a diagnosis of significant clinical importance, particularly in resource-poor rural and suburban centers across Africa. Its recognition and prompt treatment can prevent early mortality or reduce morbidity in elderly patients who present with this condition in the early stages, especially if it is the first harbinger of internal malignancy.