What is Erythrodermic Psoriasis?

Erythrodermic psoriasis is a rare, inflammatory form of psoriasis that affects a majority of the body's surface. Individuals with this form of psoriasis are at risk for developing potentially life-threatening conditions, such as pneumonia and heart failure. Treatment for this type of psoriasis is centered on infection prevention and controlling symptoms. Considered a life-long condition, this form of psoriasis is manageable with proper treatment and conscientious measures to prevent secondary infection.

Psoriasis is a genetic condition characterized by periodic episodes of irritated, itchy and flaky skin. Normally, new skin cells surface once every four weeks, during which time the old cells are shed from the skin's surface to make room for the new cells. For someone with psoriasis, this process occurs too rapidly, leading to the accumulation of excess dead cells on the skin's surface. It has been asserted that erythrodermic psoriasis originates with a malfunction of the immune system where healthy cells are mistaken for diseased, or toxic, cells, which triggers an inflammatory response.

Individuals with this type of psoriasis experience symptoms that affect a vast portion of their bodies. Sudden symptom onset may be triggered by a variety of factors that may include the abrupt discontinuation of systemic psoriasis treatment, allergic reaction to certain medications, and infection. Those with erythrodermic psoriasis may experience additional symptoms that require immediate medical treatment and, in some cases, hospitalization.

Symptoms of this condition often include a bright, red appearance to the affected area, an intense itching and irritation of the skin, and the shedding of the affected skin in large sections, as opposed to the patchy shedding of skin associated with more mild forms of psoriasis. Those in the midst of an episode may also experience an elevation in blood pressure and heart rate, intense pain, and temperature fluctuation, including chills and hot flashes. Immediate medical attention should be sought during a severe episode of erythrodermic psoriasis due to the potential risk of complications. During severe episodes, the individual may lose fluids and essential proteins, which can contribute to the development of a secondary infection.

Triggers associated with milder forms of psoriasis may also serve to trigger symptom onset in a person with erythrodermic psoriasis. The presence of infection or a cutaneous (skin) injury, excessive exposure to sunlight, or stress may trigger an onset of symptoms. Individuals with compromised immunity, as associated with autoimmune disorders, HIV/AIDS, and certain cancer therapies, who are diagnosed with erythrodermic psoriasis may experience more pronounced or severe symptoms. Additional factors which may complicate the individual's condition include the use of certain prescription medications, such as lithium, and a lack of humidity in the individual’s immediate environment.

A diagnosis of psoriasis is generally made during a physical examination. In some cases, a skin biopsy may be conducted to verify a diagnosis of psoriasis and to rule out the presence of other conditions. A skin biopsy may be conducted on an outpatient basis and involves the removal of a small, outer portion of the affected skin, which is then sent off for laboratory analysis.

There are three main treatment options for individuals diagnosed with psoriasis. Individuals with erythrodermic psoriasis generally utilize a combination of treatments to control their symptoms and prevent complications. For individuals with this form of psoriasis, systemic psoriasis medications are frequently prescribed and used in combination with topical steroidal medications.

Systemic medications may be administered, in the form of injections or pills, to treat the entire body. Individuals with severe forms of this condition may also receive medications to suppress their immune system and prevent symptom onset. Antibiotics may be administered to treat infection and prevent a worsening of symptoms and complications.

Some individuals undergo phototherapy, which is a medical procedure that utilizes ultraviolet light to treat psoriasis symptoms. Phototherapy may also be used in combination with drug treatment therapies to heighten skin sensitivity and promote successful treatment. Specialized shampoos, moisturizers, and prescription retinoids may be used topically to control psoriasis symptoms.

Individuals with erythrodermic psoriasis should keep their skin clean to prevent infection and avoid known triggers to inhibit symptom onset. Complications associated with psoriasis include an increase in the severity of associated symptoms, pain, and associated side effects common with the use of medications used to treat the condition. Complications specific to this form of psoriasis include infection, heart failure, and pneumonia.