Erythrodermic psoriasis

Author: Dr Amy Stanway, Dermatology Registrar, Waikato Hospital, Hamilton, New Zealand, 2004.


What is erythroderma?

Erythroderma is a generalised redness of the skin. It is a very severe skin condition that can be fatal. It can be the result of many inflammatory skin conditions, drugs and malignancies but in a third of cases it is due to psoriasis.

Erythrodermic psoriasis

What causes erythrodermic psoriasis?

Erythrodermic psoriasis may be precipitated by:

What are the clinical features of erythrodermic psoriasis?

Erythrodermic psoriasis usually occurs in the setting of known worsening or unstable psoriasis but may uncommonly be the first presentation of psoriasis. Onset can occur acutely over a few days or weeks, or gradually evolve over several months from pre-existing psoriasis.

Features are those of any form of erythroderma (red dry skin all over the body). 

Complications include:

  • Dehydration
  • Heart failure
  • Infection
  • Hypothermia
  • Protein loss and malnutrition
  • Oedema (swelling), particularly of lower legs
  • Death

What is the treatment for erythrodermic psoriasis?

Treatment of erythrodermic psoriasis can be difficult. Management includes:

Oral corticosteroids should be avoided if possible because withdrawal risks worsening of the erythrodermic state and may cause generalised pustular psoriasis. However, sometimes they are the only treatment that helps.

Topical tar preparations and phototherapy should also be avoided in the early treatment of erythrodermic psoriasis as they may worsen the condition.

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Related information

 

References:

  • Rosenbach M, Hsu S, Korman NJ, Lebwohl MG, Young M, Bebo BF Jr, Van Voorhees AS; National Psoriasis Foundation Medical Board. Treatment of erythrodermic psoriasis: from the medical board of the National Psoriasis Foundation. J Am Acad Dermatol. 2010 Apr;62(4):655-62.

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