Erythrodermic Psoriasis: Not Just Itchy Skin

Erythrodermic psoriasis is a particularly dangerous type of psoriasis in which nearly the entire surface of your skin breaks out in a severe inflammatory rash. The itchy skin and psoriasis pain associated with erythrodermic psoriasis can be intense, and the disease can endanger your life if you don't get treatment immediately.

Erythrodermic psoriasis is sometimes accompanied by a severe form of pustular psoriasis. The rarest form of psoriasis, erythrodermic psoriasis affects only 1 to 2 percent of the 7.5 million people in the United States who have psoriasis — typically older people, with a mean age of onset of about 50 years old. Men develop erythrodermic psoriasis more often than women.

Possible Triggers

Psoriasis is a genetic condition, but environmental factors can lead to flare- ups. Erythrodermic psoriasis triggers include:

  • Inappropriate or excessive use of corticosteroids
  • Abruptly quitting a systemic medication prescribed to treat psoriasis
  • An allergic rash caused by a medication allergy that prompts the Koebner response, which is psoriasis that develops as a result of a skin injury
  • Severe sunburn
  • Emotional stress
  • Alcoholism

Symptoms and Side Effects

Erythrodermic psoriasis usually occurs in people who already have chronic plaque psoriasis, particularly if it is unstable. However, it also can appear as a person's first-ever psoriasis outbreak, even in children. Erythrodermic psoriasis may develop gradually or occur suddenly and without warning.

A flare of erythrodermic psoriasis causes most of the surface of your skin to erupt in a fiery red outbreak, making it look as though it’s been burned. Extremely itchy skin and severe psoriasis pain are the results. Skin comes off the body in sheets as opposed to the smaller flakes normally associated with psoriasis plaque scales.

Erythrodermic psoriasis is dangerous because the skin's protective function is lost, similar to what happens in severe burns. This leaves the body vulnerable to harmful side effects that may require hospitalization, including:

  • Protein and fluid loss caused by the rapid shedding of large amounts of skin
  • Swelling caused by excess fluid retention, particularly in the ankles
  • Congestive heart failure
  • Bacterial or viral infection resulting from the inflamed skin, which could lead to pneumonia
  • Lack of control over body temperature, resulting in shivering episodes

Pustular psoriasis, which is often the underlying type of psoriasis in people who develop erythrodermic psoriasis, is called von Zumbusch pustular psoriasis. In this form of psoriasis, lesions are accompanied by the development of pustules that form, dry, peel, and then re-form. Further complicating the condition, those with erythrodermic psoriasis also are more likely to have psoriatic arthritis.

Treatment Options

People undergoing a flare of erythrodermic psoriasis should seek medical attention immediately. You may need to receive intravenous fluids to prevent dehydration and antibiotics to head off a severe and potentially life- threatening staph infection.

Doctors often will treat the skin inflammation with:

  • Topical steroids
  • Moisturizers
  • Light therapy
  • Systemic medications

Combination treatments of some or all of these approaches are often needed to reduce the inflammation and bring relief. Your doctor also might prescribe pain medication or anti-itch drugs to soothe itchy skin, anxiety, or sleeplessness.

The most effective treatment to bring erythrodermic psoriasis completely under control involves the use of systemic medications. These may include the immunosuppressive drugs methotrexate or cyclosporine, or biologic drugs that precisely target specific parts of the immune system that are causing the disease.

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