Erythrodermic psoriasis is a type of psoriasis that leads to severely inflamed and reddened skin over most of the body. The skin may look burned. There is significant shedding of dry skin, usually accompanied by severe itching and pain.
Erythrodermic psoriasis is a medical emergency and people experiencing the symptoms of erythrodermic psoriasis flare should speak to their doctor immediately.
Fortunately, erythrodermic psoriasis is relatively uncommon. According to the National Psoriasis Foundation, It is the least common type of psoriasis and may occur once or more during a lifetime in 1-2% of those with psoriasis. It generally appears on people who have unstable plaque psoriasis. It may also occur in association with von Zumbusch pustular psoriasis.
Outbreaks of erythrodermic psoriasis can be life-threatening. The damaged skin loses fluid, leading to dehydration, and is susceptible to infections. Severe cases may require hospitalization for intravenous fluids and antibiotics.
Some episodes of erythrodermic psoriasis have been found to have been triggered by a particular event.
The most common trigger of erythrodermic psoriasis is the rapid withdrawal of oral corticosteroids (prednisone). For this reason, corticosteroids are used very carefully in people with psoriasis, and if used, withdrawn slowly.
Other triggers include severe sunburn, infections, emotional stress, and alcohol consumption.
When the disorder is caught early, it may be treated with topical medications, moisturizers, oatmeal baths, and rest.
Moderate to severe cases usually require the use of systemic treatments, such as cyclosporine, methotrexate, or oral retinoids (Soriatane®). Cyclosporine is often selected because it tends to be fast-acting.
In many cases, combination therapy is required. This may include the use of a topical medication and one or to systemic medications.
A flare of erythrodermic psoriasis is usually painful and medication may required medication to control the pain and help with sleep.
After erythrodermic flare starts to subside, the psoriasis usually reverts to the way it looked before the flare. However, the fingernails and toenails may be significantly deformed.
Image courtesy of the National Psoriasis Foundation