Erythrodermic Psoriasis

Overview: What Is Erythrodermic Psoriasis?

Erythrodermic psoriasis is a rare and severe type of psoriasis. It affects about 2 percent of people living with psoriasis. [1] Erythrodermic psoriasis may be more common in Asians. [2]

Erythrodermic psoriasis often affects nearly the entire body and can be life-threatening.

Erythrodermic psoriasis disrupts your body's normal temperature and fluid balance. This may lead to shivering episodes and edema (swelling from fluid retention) in parts of the body, such as in the feet or ankles. You may also have a higher risk of infection, pneumonia, and heart failure.

Psoriasis is a chronic disease that is caused by an overactive immune system and is associated with inflammation throughout the body. Symptoms may resolve and recur throughout a person's life.

Symptoms

Erythrodermic psoriasis may appear as discoloration on more than 75% of the body surface area with or without exfoliation (skin shedding or peeling). On darker skin types, erythrodermic psoriasis may look purple or brown instead of intense redness. [3] Other symptoms include itch, ill-defined plaques, swelling, exfoliation, hair loss, nail changes, fever, chills, fatigue, dehydration, and increased heart rate. [4, 5]

See a health care provider immediately if you are experiencing the following symptoms:

Severe redness/discoloration and shedding of skin over a large area of the body
Exfoliation often occurs in large "sheets" instead of smaller scales
Skin looks as if it has been burned
Heart rate increases
Severe itching and pain
Body temperature goes up and down, especially on very hot or cold days

Causes and Triggers

The cause of psoriasis is not fully understood. Psoriasis lesions occur because the overactive immune system speeds up skin cell growth. Normal skin cells completely grow and shed (fall off) in a month. With psoriasis, skin cells do this in only three or four days. Instead of shedding, the skin cells pile up on the surface of the skin.

Inflammation caused by psoriasis can impact other organs and tissues in the body. People with psoriasis may also experience related health conditions. One in three people with psoriasis may also develop psoriatic arthritis.

Triggers of erythrodermic psoriasis include:

Allergic reaction to a medicine that causes a rash or other skin symptoms
Certain medicines, such as systemic steroids
Starting or stopping medicines
Infections/severe illness
Severe sunburn
Stress
Alcohol use

Learn more about triggers and flares by requesting a free Flare Guide and Symptom Tracker.

Diagnosis

A health care provider will take several factors into consideration when making a diagnosis for psoriasis, including:

The appearance of the skin. Discolored lesions may peel or shed.
The location of psoriasis. Erythrodermic psoriasis lesions appear on more than 75% of the body surface area.
Itch of the skin. This is a common symptom of psoriasis.

Erythrodermic psoriasis is a medical emergency and you should seek health care immediately if you experience symptoms of erythrodermic psoriasis. [4]

Treatment & Management

If you experience an erythrodermic flare, immediately contact your health care provider for treatment. The first goal for treating erythrodermic psoriasis is to get your body temperature and fluid balance back to normal. Depending on how severe your symptoms are, you may need to be hospitalized for treatment.

The treatment plan may change after your erythrodermic symptoms have cleared. Your provider may recommend:

Topicals, including over-the-counter topicals, topical steroids, and topical non-steroids
Phototherapy
Systemics, including oral, biologic, and biosimilar treatments

Prevention

There is no known way to prevent the onset of psoriasis, however, there are many ways that you can manage your triggers to reduce flares.

Outlook/Prognosis

Psoriatic disease is lifelong, and symptoms may resolve and recur throughout the lifetime.

While there is no cure for psoriasis, treatments today are more effective than ever before and research into new treatments, as well as a cure, is ongoing. Treating psoriasis can help improve symptoms and may decrease the associated inflammation that can lead to psoriasis comorbidities such as psoriatic arthritis, heart disease, and depression.

Why treat psoriasis?

Additional Resources

A young woman listens to a podcast on headphones

Psound Bytes™ podcast: What is Erythrodermic Psoriasis?

Dr. Mio Nakamura discusses erythrodermic psoriasis, including symptoms, the need for acute care, potential triggers, treatment options, and the risk of skin infections.

Listen to the episode

Psoriasis Simplified

Explore the NPF Care Path and take the first step toward getting care and living your healthiest life.

Take the next step

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Appointment Prep Kit

Get information on treatment options, tips on talking to your doctor, and a checklist of what to bring to your appointment.

Request your e-kit

Erythrodermic Psoriasis Fact Sheet

Learn about symptoms, triggers, and treatment options for erythrodermic psoriasis.

Get your fact sheet

References

Boyd, A. S., & Menter, A. (1989). Erythrodermic psoriasis. Precipitating factors, course, and prognosis in 50 patients. J Am Acad Dermatol, 21(5 Pt 1), 985-991. PMID: 2530253
Yan D, Afifi L, Jeon C, et al. A cross-sectional study of the distribution of psoriasis subtypes in different ethno-racial groups. Dermatol Online J. 2018 Jul 15;24(7):13030/qt5z21q4k2. PMID: 30261563
S Desai, MD, FAAD, personal communication, 4/28/21.
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. doi:10.1016/j.jaad.2009.05.048
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

Last updated on 03/27/2025 by the National Psoriasis Foundation.