A defining characteristic of exfoliative dermatitis is, obviously, exfoliation. The first wave of skin loss happens about 2-6 days after the start of the first patch of erythema. The skin may peel off in small sheets; don’t pull it off as your skin is thinning and you may be prone to cracks and bleeding. Indeed, one clue to a possible underlying cause of erythroderma is that the skin is growing too quickly compared to its normal rate of growth. It is also shedding too quickly, a process that is usually imperceptible to most of us. This peeling is probably associated with a protein known as CEA and we shall look at this more closely in the section on etiology.
For now, it is important to be aware that the body may be shedding about 20-30 g of skin per day, compared with about 8 g per day of normal loss. This results in an excessive loss of serum albumin, the most common blood plasma protein in the human body, and a condition known as hypoalbuminemia. Albumin is only synthesized in the liver, at the rate of about 12-25 g per day, and the normal rate of loss tends to balance this, giving a stable total of 250-500 g of albumin in humans. The average person loses about 14 g of albumin per day through a variety of mechanisms, with about 3-4 g lost through exfoliating skin. So, if the skin is shedding at 3 or 4 times its normal rate then you need to replenish about 10-15 g of albumin.
In theory, this is easily achieved by adding two to four extra eggs per day. However, this is only true if you eat them raw as cooking will denature a part of the albumin in the egg whites. This is also true with other high-protein foods that need cooking, such as meats and fish. Perhaps the best sources are dairy products, peanuts and tofu. The issue is complex and I shall investigate this further. The key thing now is that you need to increase your protein intake to compensate for the extra loss of albumin. This will be discussed at length in the Nutrition section.