Erythrodermic psoriasis most often affects people who already have a type of unstable plaque psoriasis. It can also occur at the onset of an episode of psoriasis, or alongside another rare type of psoriasis known as von Zumbusch pustular psoriasis.
Scientists are not sure exactly what causes psoriasis in general, but they suspect it might be caused by an overactive immune system. However, the cause of erythrodermic psoriasis remains unclear.
In patients with psoriasis, there is an overproduction of T cells. T cells are a kind of white blood cell that normally fends off bacteria and viruses. In psoriasis, these T cells attack healthy skin cells. The resulting increase in skin cells and T cells can lead to a range of symptoms.
Sunburn may trigger a flare of erythrodermic psoriasis.
While the exact causes of erythrodermic psoriasis are unknown, some situations can trigger a flare.
These situations include:
- Suddenly stopping psoriasis treatment
- Emotional stress
- Excessive alcohol consumption
- Allergic reactions and rashes
- Oral steroid medications
The signs and symptoms of erythrodermic psoriasis can be intense. Symptoms may start suddenly at the onset of a new case of psoriasis, or they may 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 of body temperature
These symptoms will affect most people during an erythrodermic psoriasis flare.
Because erythrodermic psoriasis can alter the chemistry of the body, people may also experience other symptoms. These symptoms include:
- Swelling, especially around the ankles
- Joint pain
- Chills or fever
The skin acts as the body's barrier layer. It is crucial to overall health. When the skin is severely damaged, which is what happens with erythrodermic psoriasis, the whole environment of the body is disrupted, leaving it susceptible to serious complications.
These complications include:
- Severe illness from protein or fluid loss
- Excess swelling from fluid retention
- Serious infections including pneumonia and sepsis
- Congestive heart failure
A physical exam can usually identify erythrodermic psoriasis. Most lab tests are not specific enough for diagnosis.
A person who has 90 percent of their body covered in severe redness and peeling will normally receive a diagnosis of erythrodermic psoriasis.
If a person notices any symptoms of erythrodermic psoriasis, it is crucial to seek immediate medical attention, because severe, life-threatening complications may occur.
Treatment and prevention
Erythrodermic psoriasis can be difficult to treat, especially if there are complications.
Excessive alcohol and smoking may trigger erythrodermic psoriasis.
Treatment options include:
- Topical steroid creams and moisturizers
- Wet dressings
- Bed rest
- Oatmeal baths
- Systemic medications, including methotrexate, acitretin, or cyclosporine
- Alpha blocking biologics
- IV fluid and electrolyte replacement
- Antibiotics to prevent or treat other infections
- Oral medications including biologics, methotrexate, or retinoids
To prevent an episode of erythrodermic psoriasis, people with psoriasis should follow their prescribed psoriasis routine and avoid certain triggers.
These triggers include:
- Cold weather
- Excessive alcohol consumption
Sometimes, however, the onset of erythrodermic psoriasis is sudden, which makes it very hard to avoid the potential triggers.
Following an erythrodermic flare, the psoriatic skin will normally return to its previous condition. However, because the chance of complications is so high, the outlook is conflicted.
Studies have shown that erythrodermic psoriasis is fatal in 4.6 to 64 percent of cases. As a result of improvements in diagnosis and treatment, however, the number of fatalities is falling.
The most common causes of death that have been linked to an erythrodermic flare-up are pneumonia, septicemia, and heart failure.
Types of psoriasis
People who have plaque psoriasis may be more likely to develop erythrodermic psoriasis.
Psoriasis refers to a group of chronic skin diseases, where the body produces skin cells at a much faster rate than usual. This results in areas of thickened, inflamed, and uncomfortable skin that may itch or hurt.
There are many types of psoriasis, and they have a range of symptoms:
Plaque psoriasis is a common form of psoriasis that affects 80 to 90 percent of people with psoriasis. It features itchy or painful areas of inflamed skin. In unstable plaque psoriasis, the plaques are not well defined. Unstable plaque psoriasis increases the risk of erythrodermic psoriasis.
Guttate psoriasis: This is characterized by small blotches on the torso. It often develops in childhood as a reaction to strep throat.
Inverse psoriasis: An infection that presents as red patches of swollen skin in folds of the body, such as around the armpits, groin, and breasts. The lesions may appear as red and shiny.
Pustular psoriasis: This type of psoriasis can be identified when pus-filled blisters and pustules appear all over the body. Fever, chills, extreme itching, and diarrhea may accompany these blisters.
Erythrodermic psoriasis: This is the rarest of all of the types of psoriasis, but it is often the most serious. It can occur alone or with some types of plaque or pustular psoriasis. It can cover the whole body with a peeling, painful, or itchy rash.