The Molting Man: Anasarca-Induced Full-Body Desquamation
Blisters and subsequent desquamation of the skin in the presence of acute edema is a well-known clinical phenomenon. In this case report, we describe a new variant that we have termed anasarca-induced desquamation in a 50-year-old man with molting of the entire cutaneous surface after acute edema, in a setting of 40-lb weight gain over 5 days. Laboratory workup for infectious causes and punch biopsies of skin lesions ruled out Stevens-Johnson syndrome and staphylococcal scalded skin syndrome, which have a similar clinical presentation to anasarca-induced desquamation. In patients with diffuse superficial desquamation in the setting of acute edema, anasarca-induced desquamation is worth investigating to avoid the use of corticosteroids and intravenous antibiotics in this inherently benign condition.
Practice Points
- The appearance of anasarca-induced desquamation can be similar to staphylococcal scalded skin syndrome and Stevens-Johnson syndrome.
- Histopathologic evaluation of this condition shows desquamation localized to the stratum corneum without epidermal necrosis.
- Careful evaluation, including bacterial culture, is required to rule out an infectious cause.
- Early diagnosis of anasarca-induced desquamation reduces the potential for providing harmful empiric treatment, such as systemic steroids and intravenous antibiotics, especially in patients known to have comorbidities.
Anasarca-induced desquamation is an inherently benign condition that mimics potentially fatal disorders, such as Stevens-Johnson syndrome, staphylococcal scalded skin syndrome, and toxic shock syndrome. Therefore, patients presenting with diffuse superficial desquamation should be assessed for the mucosal changes of Stevens-Johnson syndrome and a history of acute edema in the affected areas to avoid potentially harmful empiric treatments, such as corticosteroids and intravenous antibiotics.
Conclusion
Anasarca-induced desquamation represents a more diffuse form of edema blisters. This desquamation can mimic a potentially fatal rash, such as Stevens-Johnson syndrome and staphylococcal scalded skin syndrome.
