Erythrodermic psoriasis

Of the seven types of psoriasis, Erythrodermic psoriasis is the rarest form.

What is erythrodermic psoriasis?

Erythrodermic psoriasis is a rare and serious condition in which most of the skin surface of the body becomes inflamed and reddened.

'Erythrodermic' refers to erythroderma, a skin disorder in which the skin becomes red.

Whilst drugs and malignant tumors can bring on erythroderma, in approximately a third of cases it is due to psoriasis.

With Erythrodermic psoriasis, the inflamed skin also ex foliates (sheds) and the patient usually experiences intense itching and pain.

In some cases erythrodermic psoriasis is fatal due to its associated symptoms & complications.

Erythrodermic psoriasis triggers

In most cases of erythrodermic psoriasis, the patient already has another type of psoriasis which worsens and develops into this form.

Erythrodermic psoriasis can sometimes occur alongside von Zumbusch pustular psoriasis.

In rare instances, erythrodermic psoriasis can arise on its own without the patient already having another type of psoriasis.

Factors which can trigger an outbreak of erythrodermic psoriasis include:

  • low calcium levels
  • infections
  • coal tar based treatments (often used to treat other types of psoriasis)
  • oral corticosteroid treatment withdrawal
  • topical corticosteroid treatment withdrawal following excessive use
  • medications including anti malarial drugs, lithium and interleukin II
  • severe sunburn

Erythrodermic Psoriasis Symptoms & Complications

  • Dehydration
  • Heart Failure
  • Hypothermia
  • Infection
  • Malnutrition including protein loss
  • Pneumonia
  • Redness of the skin
  • Shedding of the skin
  • Swelling (oedema /edema)

One of the major complications of erythrodermic psoriasis is dehydration (fluid loss) and protein loss. Swelling, particularly around ankles may also develop.

Erythrodermic psoriasis upsets the body's temperature regulation. Hypothermia is a real risk and episodes of shivering are not uncommon.

Severe erythrodermic psoriasis can bring on life threatening infection, heart failure and pneumonia.

Erythrodermic Psoriasis Treatment

A person should seek medical help as soon as they have a erythrodermic psoriasis flare. Due to the severity of this condition, erythrodermic psoriasis usually requires monitored medical intervention.

Allowed to develop, the patient will be hospitalized or in close supervision from a carer so that their temperature can be regulated and intravenous fluids administered if required.

Treatment may also be given for any of the erythrodermic psoriasis symptoms or complications listed above. These may include giving antibiotics, diuretics and nutritional supplements.

In severe cases, bed rest is usually mandatory. Wet dressings which cool the skin and emollients which smooth and soften the inflamed skin tissue will be of benefit particularly during the early stages.

Drugs may be administered which may include low doses of:

  • actiretin
  • ciclosporin
  • methotrexate

Treatments associated with treating other types of psoriasis such as oral corticosteroids, coal tar based products and phototherapy can make the symptom of skin redness worse.

Such treatments are usually avoided until there is a marked reduction in overall redness.