An Overview of Erythrodermic Psoriasis

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Erythrodermic psoriasis is a rare, but very severe, form of psoriasis. It causes a widespread, bright-red rash that is itchy and painful. Skin will peel off in large sheets. Erythrodermic psoriasis can have life-threatening complications and must be treated by a doctor.

Erythrodermic psoriasis is sometimes called exfoliative psorasis.

Symptoms

Erythrodermic psoriasis is a severe variant of the more common plaque psoriasis. This skin condition is quite rare, but when it does develop it's very serious and includes the following reactions:

  • Widespread rash: The most notable symptom of erythrodermic psoriasis is a bright-red, inflammatory rash that covers a huge area of skin (at least 75 percent of the entire body) and looks as if the skin has been burned. The rash is both painful and itchy.
  • Severe skin peeling: Skin will slough off in large pieces, and small, fluid-filled blisters may also form.
  • Systemic symptoms: Chills, fever, pain in the joints, swelling of the lower legs and ankles, fluctuating body temperature, and rapid heartbeat are all common.

Erythrodermic psoriasis may develop slowly over the course of several months, as a worsening of existing psoriasis. In other cases, it develops quite rapidly over several days time.

If you have symptoms of erythrodermic psoriasis it's imperative that you call your doctor immediately. This form of psoriasis can have severe, potentially life-threatening complications.

The skin is an integral part of your body's health, serving as both an organ of protection and heat regulation. Having a large area of skin damaged can lead to very serious complications, like low body temperature (hypothermia) and dehydration. Because the skin is compromised, infection can easily take hold.

Pneumonia, heart failure, and sepsis are very dangerous complications of this skin disease.

Causes

What causes erythrodermic psorasis isn't clear. It's an autoimmune disorder, meaning your body has overactive immune system response.

Erythrodermic psoriasis is most common in those who already have psoriasis, especially if psoriasis plaques don't have well-defined borders. It's estimated that 1 to nearly 3% of people with psoriasis will develop the erythrodermic form. But in rare cases, it appears in someone who has never had psoriasis before.

There are certain factors that may trigger an episode in some people. They include:

  • Severe sunburn
  • Infection (i.e. upper respiratory infection)
  • Excessive alcohol consumption
  • Taking or stopping oral steroids
  • Reaction to a medication, such as lithium or interleukin II
  • Skin trauma (i.e. incision, injury)

Diagnosis

There isn't a specific test to check for erythrodermic psoriasis. Instead, it's diagnosed by ruling out other skin diseases.

Diseases that may also cause a widespread, peeling rash include:

In most cases, your doctor will diagnose erythrodermic psoriasis by examining your skin and taking your medical history. Your doctor may also order a skin biopsy.

Treatment

Treatment of erythrodermic psoriasis is complicated. You will most likely need a combination of both systemic and topical medications to get the condition under control.

Depending on your situation, your doctor may choose to have you admitted to the hospital for treatment.

The most commonly used drugs to treat erythrodermic psoriasis include:

  • Cyclosporine: Cyclosporine is considered first-line therapy for erythrodermic psoriasis. This drug lowers the immune system response and works quickly to reduce widespread inflammation. It's often chosen because, quite simply, it works fast.
  • Remacide (infliximab): This is also used as a first-line treatment for erythrodermic psoriasis. It is a TNF inhibitor; it targets tumor necrosis factor (TNF), and protein that when overproduced by the body leads to inflammation. It also works fairly quickly.
  • Soriatane (acitretin): This oral medication is used to control the overproduction of skin cells, as it slows down cell growth.
  • Methotrexate: Methotrexate medications (like Trexall, Otrexup, Rasuvo) also work by controlling cell growth.
  • Other biologic drugs: Your doctor may also choose to use other biologics such as Humira (adalimumab), Enbrel (etanercept), Cosentyx (secukinumab), or Stelara (ustekinumab).

You may need to be on these medications for a long period of time to prevent a relapse. Many people who have had one episode of erythrodermic psoriasis will have another flare-up at some point.

Additional Treatments

Erythrodermic psoriasis can be very uncomfortable. Your doctor may also recommend specific treatments to maintain your comfort while the skin heals.

  • Wet wrap therapy can be used to soothe skin and relieve itching. This consists of layering damp cloth or gauze over the affected areas, followed by a dry dressing. The wraps can then be worn for several hours. Ask your doctor if this is right for your particular situation, and for detailed instructions.
  • Topical steroid creams and moisturizing ointments won't treat erythrodermic psoriasis on their own, but they can help relieve discomfort and itching.
  • Oral antibiotics may be used to treat or prevent infection.
  • Anti-itch medications or pain relievers are also prescribed in many situations, especially to allow to become comfortable enough to sleep.
  • Bed rest is important to allow your body to heal.

Coping

Because it causes such severe symptoms that cover such a large area of your body, having an erythrodermic psoriasis can be a terrifying experience. You may feel like your body is out of control.

Lean on your support system during this time, whether that be family members, friends, and the medical team treating you. Meditation may help reduce stress and anxiety. In some cases anti-anxiety medications may be helpful.

Lastly, rest. Your body is healing from a debilitating condition. Allow yourself time to recover. Get help from friends and family.

A Word From Verywell

Erythrodermic psoriasis is a very rare skin condition. Still, if you have psoriasis you should be aware of the symptoms. If you believe that you may have erythrodermic psoriasis, it's very important that you contact your doctor right away. Getting immediate treatment can help minimize the chance of developing serious, possibly life-threatening complications.

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  1. American Academy of Dermatology. Psoriasis: signs and symptoms.

  2. Singh RK, Lee KM, Ucmak D, et al. Erythrodermic psoriasis: pathophysiology and current treatment perspectives. Psoriasis (Auckl). 2016;6:93-104. doi:10.2147/PTT.S101232

  3. Singh RK, Lee KM, Ucmak D, et. al. Erythrodermic psoriasis: pathophysiology and current treatment perspectives. Psoriasis (Auckl). 2016;6:93-104. doi: 10.2147/PTT.S101232.

  4. Navrotski BRF, Nihi FM, Camilleri MJ, Cerci FB. Wet wrap dressings as a rescue therapy option for erythrodermic psoriasis. An Bras Dermatol. 2018;93(4):598-600. doi:10.1590/abd1806-4841.20186414