Erythrodermic psoriasis can cause extreme pain and has the potential to be fatal
Erythrodermic psoriasis (EP) or erythroderma is a severe type of psoriasis that causes extensive peeling, severe itching, and rashes across the entire surface of the body.
This type of psoriasis is quite rare, affecting about 1%-2.5% of people with psoriasis. It is more common in people with unstable plaque psoriasis.
In addition to extreme pain, EP has the potential to be fatal. Damage to the skin may cause loss of heat and electrolyte imbalances, which can be life-threatening. Seek medical assistance immediately if you suspect you have EP.
What are signs and symptoms of erythrodermic psoriasis?
Symptoms of erythrodermic psoriasis (EP) can be severe. Symptoms may appear quickly at outset or gradually throughout a plaque psoriasis flare.
Signs and symptoms of EP include:
- Red patches on the skin
- Small scaly patches
- Dry, cracked skin
- Itching
- Burning
- Soreness
- Thickened nails
- Pitted or ridged nails
- Stiff or swollen joints
- Genital sores in males
- Severe dandruff
- Increased heart rate
- Body temperature fluctuations
EP develops progressively in people with plaque psoriasis. Symptoms of psoriasis may worsen and fail to respond to therapy.
What are causes and risk factors for erythrodermic psoriasis?
Erythrodermic psoriasis (EP) usually affects people who already have psoriasis. Experts are unsure exactly what causes this severe type of psoriasis, but according to the National Psoriasis Foundation, it often appears in people with unstable plaque psoriasis (where psoriasis lesions are not clearly defined).
This condition may be caused by both hereditary and environmental causes. Common causes and risk factors for EP include:
- Pre-existing psoriasis
- Family history
- Alcohol use
- Vitamin D deficiency
- Stress
- Skin injury
- Dry skin
- Acquired immunodeficiency syndrome
- Autoimmune disorders
- Chemotherapy
- Smoking
- Viral and bacterial infections
- Obesity
- Smoking
- Medications (antimalarials, lithium, trimethoprim/sulfamethoxazole, Bactrim, and Septra)
- Rebound phenomena following rapid discontinuation of systemic psoriasis therapy, including steroids
- Severe sunburn, skin damage, or trauma, including drug-induced allergic rash (Koebner phenomenon)
- Male sex
- Age (it occurs at a median age of 53.7 years)
What are treatment options for erythrodermic psoriasis?
Erythrodermic psoriasis (EP) has no cure, but various treatment options can minimize symptoms. EP treatment typically requires hospitalization. The initial stage is to restore fluid and electrolyte balance and stabilize essential organs such as the heart. The illness can then be treated, generally with a combination of medications.
Treatment options for EP may include:
- Antibiotics to prevent infection
- Biologics
- Systemic medications
- Topical treatments, including wet dressings, oatmeal baths, moisturizers, and corticosteroid ointments
- Combination therapy of pain medications, anti-itch ointments, and sleep aids
Treating people with EP generally involves the following:
- The first line of therapy is topical steroids to reduce inflammation.
- This is followed by moisturizers, wet dressings, and bed rest to relieve discomfort and itching.
- If this doesn't work, hospitalization may be required, where fluid depletion can be managed with intravenous fluids.
- Therapy often involves the use of topical steroids and systemic immunosuppressive drugs, as well as regular cardiac and pulmonary monitoring.
- Oatmeal baths and hydration may be recommended.
- Common psoriasis medications include oral cyclosporine or infusions of infliximab.
Procedures for the treatment of EP include:
- Ultraviolet B (UVB) phototherapy: Improves mild to moderate psoriasis symptoms
- Narrow band UVB phototherapy: Improves mild to moderate psoriasis symptoms
- Goeckerman therapy: Improves mild to moderate psoriasis symptoms
- Psoralen plus ultraviolet A therapy: Treats more severe cases of psoriasis
- Excimer laser therapy: Improves mild to moderate psoriasis symptoms
EP may resolve within 3 months if treated properly under expert supervision.
QUESTION
Psoriasis causes the top layer of skin cells to become inflamed and grow too quickly and flake off.
See Answer
Can erythrodermic psoriasis be prevented?
Because the cause is unknown, EP is not necessarily preventable. However, you may be able to reduce your risk of developing the condition by avoiding identified triggers. If you have psoriasis or psoriatic arthritis, talk to your doctor about your risk factors as well as strategies to protect yourself.
To prevent an episode of EP, avoid triggers such as:
Other prevention tips may include the following:
- Aloe vera: Helps reduce redness, scaling, itching, and inflammation
- Fish oil supplements: Helps reduce inflammation
- Oregon grape: Helps reduce inflammation
Sometimes, however, the onset of EP is sudden, which makes it very hard to avoid potential triggers.
What is the prognosis for people with erythrodermic psoriasis?
Following an erythrodermic flare-up, the skin usually returns to its pre-flare state. However, because of the possibility of severe complications, the outlook is mixed:
- EP is associated with fatal outcomes in 4.6%-64% of cases. However, as diagnosis and treatment methods improve, the incidence of deaths is decreasing.
- Pneumonia, septicemia, and heart failure are the most common causes of mortality associated with an erythrodermic flare-up.
- The two EP subtypes have slightly distinct prognoses.
- People with plaque psoriasis who progress to EP have a better prognosis. Disease progression is largely steady.
- Prognosis is poor when EP develops quickly in the absence of plaques. Disease progression is fast, unstable, and can cause relapses.
You can expect your skin to return to normal after the flare-up has calmed down. It is critical, however, to contact your dermatologist as soon as you see signs of EP, since EP is considered a medical emergency.
