Erythrodermic psoriasis: What you need to know
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.
Symptoms can appear gradually or suddenly and need medical treatment.
Scientists are not sure exactly what causes psoriasis, but it appears to be due to an overactive immune system.
Why erythrodermic psoriasis develops, however, remains unclear.
In people with psoriasis, the body produces an excessive number of T cells, which are a kind of white blood cell that usually fends off bacteria and viruses.
In psoriasis, these T cells attack healthy skin cells. An overproduction of skin cells occurs as a result, alongside 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.
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
Erythrodermic psoriasis features a fiery red rash across the body. Image credit: James Heilman MD, 2010.
The signs and symptoms of erythrodermic psoriasis can be intense.
Symptoms may appear 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 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.
- swelling, especially around the ankles
- joint pain
- chills or fever
The skin acts as the body's barrier layer, and it 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 90 percent of their body will typically receive a diagnosis of erythrodermic psoriasis.
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.
A person may need to spend time in the hospital where treatment includes IV fluids for rehydration.
Erythrodermic psoriasis can be difficult to treat, especially if complications develop.
Treatments include topical treatments and drug therapy. A person's treatment options will depend on the severity of their symptoms and the presence of any other health conditions.
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 infliximab (Remicade) are standard first-line treatments for erythrodermic psoriasis.
The medical board of the National Psoriasis Foundation note that these appear to be the fastest-acting therapies.
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 etanercept (Enbrel), or using combination therapy.
Biologic drugs, such as etanercept or adalimumab (Humira), 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, if their condition is stable, and they are not losing fluids, outpatient treatment may be possible. 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 antiretroviral therapy or ultraviolet (UV) phototherapy.
After this, the person may receive acitretin. Other treatments may not be effective in treating people with HIV who develop erythrodermic psoriasis.
To prevent an episode of erythrodermic psoriasis, people with psoriasis should follow their prescribed psoriasis routine and avoid specific triggers.
These may include:
- cold weather
- excessive alcohol consumption
Sometimes, however, the onset of erythrodermic psoriasis is sudden, which makes it hard to avoid the potential triggers.
In most people with erythrodermic psoriasis, the condition responds to a treatment or a combination of treatments.
Past research data show that erythrodermic psoriasis may have led to fatal complications in 4.6–64.0 percent of cases. Pneumonia, septicemia, and heart failure are the most common life-threatening complications.
However, improvements in diagnosis and treatment mean that the number of fatalities is falling.
Other types of psoriasis
Psoriasis is a chronic condition in which the body produces skin cells at a much faster rate than usual. This overproduction of cells results in areas of thickened, inflamed, and uncomfortable skin that may itch or hurt. It can also affect other parts of the body, including the joints.
There are many types of psoriasis, and they have a range of symptoms:
Plaque psoriasis is the most common form. It affects 80 to 90 percent of people with psoriasis and features itchy or painful areas of inflamed skin. Unstable plaque psoriasis involves poorly defined plaques, and it increases a person's risk of erythrodermic psoriasis.
Inverse psoriasis presents as red, shiny patches of swollen skin in folds of the body, especially the armpits, groin, and under the breasts.
Pustular psoriasis involves pus-filled blisters and pustules that appear all over the body. Fever, chills, extreme itching, and diarrhea may accompany these blisters. Erythrodermic psoriasis can develop as a complication.