What Is Erythrodermic Psoriasis?
Reviewed by: HU Medical Review Board | Last reviewed: July 2016. | Last updated: June 2023
Erythrodermic psoriasis is a rare but extremely serious form of psoriasis, a chronic autoimmune disease that appears on the skin. People with this form of the disease develop very red and scaly skin over 90% or more of their bodies.1 This is can be very itchy and painful to the touch, and the person may start to shed sheets of skin.
Flare-ups of erythrodermic psoriasis require urgent medical care3. If it is not treated, it can cause complications or even life-threatening. Contact a healthcare provider immediately if you develop symptoms of erythrodermic psoriasis.
What are the possible triggers for erythrodermic psoriasis?
Plaque psoriasis is an inflammatory condition that causes patches of reddened, thickened, and scaly skin to develop due to excess skin cell production. Around 30% of people who develop erythrodermic psoriasis are people who already have plaque psoriasis. This usually happens if the person has been having more frequent and severe flare-ups of plaque psoriasis that are not controlled well enough, and gradually affect more and more of a person’s body.2
The most common trigger for a flare-up of erythrodermic psoriasis is stopping treatment with corticosteroids too quickly. Corticosteroids are powerful medicines that reduce the amount of inflammation in the body, which can help to relieve symptoms of psoriasis that are caused by inflammation.3 Corticosteroid medicines can be applied directly to the skin (topically), they can be taken by mouth, or they can be injected with a shot or by infusion. Because they are so powerful, if a person stops taking corticosteroids too quickly, it can cause serious side effects. For this reason, healthcare providers help patients to gradually reduce the dose of their corticosteroids over time, instead of stopping all at once.4
Other possible triggers for a flare-up of include:
- Taking strong corticosteroid medications, such as cortisone or prednisone
- Severe sunburn
- Use of strong coal tar preparations
- Taking certain medications, such as lithium or antimalarial medicine
- Drinking alcohol excessively
- Having low levels of calcium in the body
- Inflammatory skin conditions other than psoriasis
What are the possible complications of erythrodermic psoriasis?
The reason it is so important to treat erythrodermic psoriasis right away is due to the very serious complications that it can cause.2
Some of these possible complications include:3
- Dangerously low body temperature (hypothermia)
- Heart failure
- Protein loss and malnutrition
- Swelling of the arms and legs
Because of the way erythrodermic psoriasis affects the skin, it can also put a patient at higher risk of getting certain types of dangerous infections4, such as staphylococcus (“staph” for short).
How common is erythrodermic psoriasis?
Erythrodermic psoriasis is very rare: only about 1% of psoriasis patients have erythrodermic psoriasis. This form of the disease affects more men than women, and it more commonly affects older people. People are around 50 years old, on average, when they have the first flare up of erythrodermic psoriasis.5
How is erythrodermic psoriasis treated?
Treatment for erythrodermic psoriasis is complicated because the condition is so serious. Most people need to check into the hospital so that they can receive all of the different types of care that they need.2 Bed rest is usually advised, and patients will usually need intravenous fluids and/or nutrition to prevent dehydration or malnutrition.
Medicines used to treat erythrodermic psoriasis are very dependent on the particular patient’s condition, but may include antibiotics, methotrexate, cyclosporine, acitretin, or biologic therapies. Emollients and dressings are often used to provide symptom relief during treatment.