Erythrodermic psoriasis
Erythrodermic [eh-REETH-ro-der-mik] psoriasis is a particularly inflammatory form of psoriasis that often affects most of the body surface. It may occur in association with von Zumbusch pustular psoriasis. It is characterized by periodic, widespread, fiery redness of the skin. The erythema (reddening) and exfoliation (shedding) of the skin are often accompanied by severe itching and pain.
Patients having an erythrodermic psoriasis flare should make an appointment to see a doctor immediately. Erythrodermic psoriasis causes protein and fluid loss that can lead to severe illness. Edema (swelling from fluid retention), especially around the ankles, may also develop along with infection. The body's temperature regulation is often disrupted, producing shivering episodes. Infection, pneumonia and congestive heart failure brought on by erythrodermic psoriasis can be life threatening. People with severe cases of this condition often require hospitalization.
Known triggers of erythodermic psoriasis include abrupt withdrawal of systemic treatment; the use of systemic steroids (cortisone); an allergic, drug-induced rash that brings on the Koebner response (a tendency for psoriasis to appear on the site of skin injuries); and severe sunburns.
Initial treatment usually includes medium-potency topical steroids and moisturizers, combined with wet dressings, oatmeal baths and bed rest. Antibiotics may also be used. Careful attention is paid to restoring and maintaining fluids in the body.
In addition, methotrexate, Soriatane or cyclosporine are frequently required to bring severe cases under control. Use of systemic steroids for erythrodermic psoriasis is controversial, and if used, they should be tapered off slowly. Stopping them suddenly can trigger a flare of psoriasis. UVB or PUVA treatment is usually held in reserve until the degree of redness has improved.
Updated December 2005
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