Erythrodermic psoriasis is an uncommon, aggressive, inflammatory form of psoriasis. Symptoms include a peeling rash across the entire surface of the body. The rash can itch or burn intensely and spread quickly, and needs immediate medical treatment.
Erythrodermic psoriasis is one of the most severe types of psoriasis. If complications develop, it can be life threatening.
The condition most often affects people who already have unstable plaque psoriasis.
It can also occur at the onset of an episode of plaque psoriasis or alongside another rare type of psoriasis called von Zumbusch pustular psoriasis.
The signs and symptoms of erythrodermic psoriasis can be intense.
Symptoms may appear suddenly at the onset of psoriasis or begin gradually during a plaque psoriasis flare.
Symptoms of erythrodermic psoriasis include:
- severe skin redness over a large part of the body
- skin shedding that occurs in large sheets rather than smaller flakes or scales
- pustules or blisters
- burnt-looking skin
- severe itching
- intense pain
- increased heart rate
- fluctuations in body temperature
These symptoms will affect most people during an erythrodermic psoriasis flare.
Erythrodermic psoriasis can alter the chemistry of the body. For this reason, people may also experience other symptoms.
Scientists are not sure exactly what causes psoriasis, but it appears to be due to an overactive immune system.
However, it remains unclear why erythrodermic psoriasis develops.
When a person has psoriasis, the body produces an excessive number of T cells, which are a kind of white blood cell that usually fight off bacteria and viruses.
In psoriasis, these T cells attack healthy skin cells. This causes an overproduction of skin cells occurs and other symptoms.
The symptoms of psoriasis mostly appear on the skin, but the condition can also affect the nails, joints, and other parts of the body.
Erythrodermic psoriasis can be difficult to treat, especially if complications develop.
Topical treatments include:
- topical steroid creams and moisturizers
- wet dressings
- oatmeal baths
Emergency treatment consists of IV fluid and electrolyte replacement to treat or prevent dehydration.
Some systemic medications, which affect the whole body, are also available. The doctor may prescribe oral medication or deliver the drug through an injection or an infusion.
Cyclosporine (Neoral) and Remicade (infliximab) are standard first-line treatments for erythrodermic psoriasis.
Some doctors may prescribe methotrexate (Otrexup) or acitretin (Soriatane) instead, but these work more slowly.
Once a person’s condition is stable, the doctor may recommend changing to another drug, possibly Enbrel (etanercept), or using combination therapy.
Biologic drugs, such as etanercept or Humira (adalimumab), which are tumor necrosis factor (TNF)-alpha inhibitors and some interleukin (IL) agents, are effective treatments for moderate to severe erythrodermic psoriasis.
Newer biologics target different genes.
A doctor may also prescribe antibiotics to prevent or treat other infections if necessary.
The person may need to spend time in the hospital. However, outpatient treatment may be possible if their condition is stable and they are not losing fluids. The person may need bed rest.
People with HIV
People living with HIV have a higher risk of developing psoriasis, including erythrodermic psoriasis, and it is likely to be harder to treat.
For a person with HIV and erythrodermic psoriasis, treatment may start with
After this, the person may receive acitretin. Other treatments may not effectively treat people with HIV who develop erythrodermic psoriasis.
The exact causes of erythrodermic psoriasis are unclear, but some factors can trigger a flare.
- suddenly stopping psoriasis treatment
- the use of certain psoriasis treatments
- the overuse of corticosteroids
- emotional stress
- excessive alcohol consumption
- allergic reactions and rashes
- oral steroid medications
The skin acts as the body’s barrier layer, which is crucial to overall health.
The severe damage to the skin resulting from erythrodermic psoriasis disrupts the whole environment of the body.
The body becomes susceptible to serious complications, including:
- severe illness from loss of protein or fluid
- excessive swelling from fluid retention
- severe infections, including pneumonia and sepsis
- congestive heart failure
Complications due to bacterial infection can become life threatening.
Doctors can usually identify erythrodermic psoriasis by carrying out a physical examination. Most laboratory tests are not specific enough to confirm a diagnosis.
A person who has severe redness and peeling covering
The doctor will also check for signs of infection, as extensive damage to the skin will leave the body vulnerable.
It is crucial that anyone who notices any symptoms of erythrodermic psoriasis seeks immediate medical attention because severe, life threatening complications may occur.
In some cases, the doctor may admit the individual to the hospital.
People with psoriasis should follow their prescribed psoriasis routine and avoid specific triggers to prevent an episode of erythrodermic psoriasis.
These may include:
- cold weather
- excessive alcohol consumption
Sometimes, however, the onset of erythrodermic psoriasis is sudden, making it hard to avoid the potential triggers.
In most people with erythrodermic psoriasis, the condition responds to a treatment or a combination of treatments.
Pneumonia, septicemia, and heart failure are the most common life threatening complications.
Past research data show that erythrodermic psoriasis may have led to fatal complications in