Clinical Characteristics, Etiologies, Management, and Outcomes of Adult Exfoliative Dermatitis at Chao Phraya Abhaibhubejhr Hospital, Thailand: A Prospective Cohort Study

Introduction Adult exfoliative dermatitis (ED) is a severe inflammatory dermatosis with heterogeneous etiologies and substantial morbidity. Hospital-based prospective data remain limited in Thailand. We aimed to prospectively describe the clinical characteristics, etiologies, management, and outcomes of adults with ED at a tertiary-care hospital in Thailand, and to assess changes during follow-up. Methods We conducted a prospective hospital-based cohort study enrolling consecutive adults diagnosed with ED from November 2024 to March 2026. Baseline demographics, comorbidities, prior treatments, clinical manifestations, and disease severity were recorded. Etiology was determined by clinicopathologic correlation and treating-physician adjudication. Patients were followed longitudinally for up to 12 months after diagnosis, and changes in disease severity and clinical outcomes were assessed during follow-up. Analyses were primarily descriptive. Exploratory comparisons across follow-up visits were reported using nonparametric tests with corresponding p-values. Results Thirty-four patients were recruited; two were lost to follow-up, and one had incomplete baseline data, leaving 31 for analysis. The mean age was 58.0 ± 18.2 years, and 74.2% were male. Most were managed as outpatients (67.7%), while 32.3% required hospitalization. Pruritus, scaling, and erythema were present in all patients. Nail involvement was frequent (64.5%), whereas pustules and mucosal involvement were uncommon (6.5% each). Systemic features occurred in a subset, including arthritis (25.8%), fever (16.1%), edema (16.1%), and lymphadenopathy (6.5%). Conclusions In this prospective hospital-based cohort, adult ED demonstrated uniform core cutaneous features with variable systemic involvement and a substantial proportion requiring hospitalization. These findings provide pragmatic clinical profiles to support early recognition and structured evaluation of etiology and complications in routine practice.