Erythroderma (Generalized Exfoliative Dermatitis) Medication

Updated: Oct 15, 2020
  • Author: Sanusi H Umar, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
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Medication Summary

Topical steroids are the primary category of medications used to treat exfoliative dermatitis (ED). A sedative antihistamine may be a useful adjunct for pruritic patients, since it helps patients to sleep at night, thus limiting nocturnal scratching and excoriations. Antimicrobial agents often are used if an infection is suspected to be precipitating or complicating exfoliative dermatitis. Biologics are the most rapidly growing treatment option, with their use most common in psoriasis. Other drugs specifically indicated for management of underlying etiology of exfoliative dermatitis may be necessary.


Topical steroids

Class Summary

Topical steroids exert anti-inflammatory effects by inhibiting early processes (eg, edema, fibrin deposition, capillary dilatation, movement of phagocytes into the area, phagocytic activities). In exfoliative dermatitis, they may inhibit the increased epidermal cell turnover that occurs. Indications include symptomatic relief of inflammation and/or pruritus associated with acute and chronic corticosteroid-responsive disorders.

Triamcinolone topical (Aristocort)

Triamcinolone topical is a medium-potency topical steroid. Use creams and lotions for moist weepy lesions and with intense inflammation (eg, exfoliative dermatitis). The frequency of use in exfoliative dermatitis depends on the acute nature of the disease and the frequency with which wet dressings are changed.



Class Summary

Antihistamines exert both antipruritic and sedating effects. They are used in treating histamine-mediated allergic reactions by competitively inhibiting H1 receptors on effector cells. To varying degrees, they exert sedative effects by crossing the blood-brain barrier and blocking central histaminogenic receptors.

Hydroxyzine (Atarax, Vistaril)

Hydroxyzine antagonizes H1 receptors in the periphery. It may suppress histamine activity in the subcortical region of the central nervous system, providing antipruritic effects.


Calcineurin Inhibitors

Class Summary

Calcineurine inhibitors regulate key factors responsible for inflammatory response.

Cyclosporine (Gengraf, Neoral, Sandimmune)

Cyclosporine is an immunosuppressant drug approved for the treatment of psoriasis. It is among the most effective systemic therapeutics available for psoriasis, although it is not applicable for long-term use due to its toxicities.



Class Summary

Treatment with systemic retinoids may be considered.

Bexarotene (Targretin)

Bexarotene is an oral synthetic retinoid for the treatment of mycosis fungoides and refractory cutaneous T-cell lymphoma that can be used as monotherapy or in combination with other options, such as phototherapy. It has been found to be less effective in very advanced stages of cutaneous T-cell lymphoma.


Histone Deacetylase Inhibitors

Class Summary

Histone deacetylase inhibitors were developed to inhibit the dysregulation of histone deacetylase enzymes that causes epigenetic changes and contributes to cancer development. Histone deacetylase inhibitors are effective in stopping the growth, cell differentiation, and apoptosis in malignant cutaneous T-cell lymphoma.

Vorinostat (Zolinza)

Vorinostat is an oral, chemotherapeutic histone deacetylase inhibitor approved for the treatment of cutaneous T-cell lymphoma.

Romidepsin (Istodax)

Romidepsin (depsipeptide or FK228) is an intravenous histone deacetylase inhibitor approved for patients with relapsed or refractory cutaneous T-cell lymphoma.

Belinostat (Beleodaq)

Belinostat is an intravenous pan-histone deacetylase inhibitor for patients with relapsed or refractory cutaneous T-cell lymphoma.



Class Summary

Various biologic products may be considered that are currently approved for psoriasis (eg, tumor necrosis factor [TN]F inhibitors, interleukin [IL] inhibitors, phosphodiesterase type 4 [PDE-4] inhibitors).

Infliximab (Remicade)

Infliximab is a monoclonal antibody and cytokine modulator that inhibits TNF-alpha. It is approved for intravenous injection in patients with psoriasis.

Adalimumab (Humira)

Adalimumab is a monoclonal antibody and cytokine modulator that inhibits TNF-alpha. It is approved for subcutaneous injection in patients with psoriasis.

Etanercept (Enbrel)

Etanercept is a fusion protein that binds to both TNF-alpha and TNF-beta and inhibits TNF-alpha. It is approved for subcutaneous injection in patients with psoriasis.

Ustekinumab (Stelara)

Ustekinumab is an anticytokine protein that targets IL-12/Th1 and IL-23/Th17, inhibiting both of their pathways. It is approved for subcutaneous injection in patients with psoriasis.

Secukinumab (Cosentyx)

Secukinumab is a monoclonal antibody that inhibits IL-17A. It is approved for subcutaneous administration in patients with psoriasis.

Apremilast (Otezla)

Apremilast an oral small molecule approved for the treatment of psoriasis that degrades PDE-4 and interferes with cyclic antimicrobial peptides.