What is erythrodermic psoriasis?

Erythrodermic psoriasis is the least common, but most severe type, of psoriasis. This form of psoriasis covers >80% of the body with red, scaly, peeling lesions.

It is an extremely rare condition and may only happen once or twice in the lifetime of 1-2% of people with psoriasis, and tends to happen slightly more in adult males than females.^1,2 This condition may happen gradually in a person with unstable plaque psoriasis or suddenly in someone who has never had psoriasis. Some of its triggers include severe sunburn, drug-induced allergic rash, alcoholism, and most commonly, rapid withdrawal of oral psoriasis medications.³

Symptoms

Erythrodermic psoriasis can itch and burn immensely, especially in the areas with lots of scaling. The skin swells and sheds multiple layers, often in large sheets.⁴ Other symptoms may include fever, chills, general malaise, racing heart rate, joint pain, and lymph node swelling.²

Diagnosis

Quick recognition of this potentially life-threatening condition is extremely important. A detailed history and thorough physical examination are very important to establish this diagnosis and rule out other conditions that can look very similar to erythrodermic psoriasis. This is a necessary, but very challenging task. While skin biopsies are generally not needed to diagnose psoriasis, this is a case where a skin biopsy is generally warranted.⁵ There are no specific lab tests that confirm erythrodermic psoriasis, but blood tests are often used to help guide treatment and rule out other causes of similar symptoms.

Treatment

Erythrodermic psoriasis may be life-threatening, and as such, could require hospitalization. The loss of large areas of skin disrupts the body’s chemistry and may lead to severe illness, such as infection, pneumonia, and congestive heart failure. The body will often have difficulty maintaining normal body temperature and fluid levels. The mainstay of treatment for this type of psoriasis is fluid and electrolyte replacement, nutritional support, and prevention of infection through skin and wound care.³ The initiation of an oral psoriasis medication is essential for maintaining disease control in the long run.

References

1. Lebwohl M. Psoriasis. The Lancet. 2003;361(9364):1197-1204.
2. Boyd AS, Menter A. Erythrodermic psoriasis. Precipitating factors, course, and prognosis in 50 patients. J Am Acad Dermatol. 1989;21(5 Pt 1):985-991.
3. Rosenbach M, Hsu S, Korman NJ, et al. Treatment of erythrodermic psoriasis: from the medical board of the National Psoriasis Foundation. J Am Acad Dermatol. 2010;62(4):655-662.
4. Nicolis GD, Helwig EB. Exfoliative dermatitis. A clinicopathologic study of 135 cases. Arch Dermatol. 1973;108(6):788-797.
5. Tomasini C, Aloi F, Solaroli C, Pippione M. Psoriatic erythroderma: a histopathologic study of forty-five patients. Dermatology. 1997;194(2):102-106.