Is Erythrodermic Psoriasis Rare? Symptoms & Treatment

Erythrodermic psoriasis causes red and scaly skin plaques that cover more than 90% of the body. Skin may be extremely itchy, painful to the touch, and shed in sheets.

Symptoms of erythrodermic psoriasis include:

• Severe skin redness
• Skin shedding in sheets instead of flakes
• Burnt-looking skin
• Blisters and pustules
• Severe itching and pain
• Hair loss
• Thickened nails
• Irregular or elevated heartbeat
• Fever or chills
• Body temperature fluctuations
• Weight fluctuations
• Weakness
• Dehydration
• Joint pain and swelling
• Diarrhea or constipation

Some people have a rapid onset of symptoms that necessitates aggressive treatment, whereas others may have more gradual symptoms that can be treated more conservatively.

Erythrodermic psoriasis can make you more susceptible to infection, pneumonia, and heart failure. Since complications can become life-threatening, it is critical to seek medical treatment.

While the cause of erythrodermic psoriasis is unknown, certain factors can trigger a flare.

Erythrodermic psoriasis can develop in people who have had psoriasis vulgaris for a long period of time or as the first manifestation of psoriasis. Triggers may include

• Abrupt stopping of corticosteroids, such as cortisone or prednisone
• Overuse of corticosteroids
• Severe sunburn
• Infections
• Emotional stress
• Certain medications (antimalarial, beta-blockers, lithium, nonsteroidal anti-inflammatory, angiotensin-converting enzyme inhibitors)
• Excessive alcohol consumption
• Low calcium levels
• Allergic reactions and rashes
• Other inflammatory skin conditions

Treatment options for erythrodermic psoriasis may include:

• Antibiotics in addition to topical treatments
• Bed rest and wet dressings to control other infections
• Oral corticosteroids and alpha-blocking biologics in severe cases.
• Phototherapy treatments should be avoided until skin redness has subsided

Tips for managing erythrodermic psoriasis include the following:

• Topical treatments
  • Emollients and topical steroid creams may be prescribed.
  • Apply the cream to infected areas as directed. 
  • After applying topical treatments, apply wet dressings.
• Wet dressings
  • Place disposable towels in a bowl of room temperature water. 
  • Wrap the wet towels over and around infected areas and use crepe bandages to hold them in place.
  • Do not let the bandages come into contact with infected areas of the skin.
• Oatmeal bath
  • Oatmeal baths may be recommended to relieve pain and itching. Oatmeal has anti-inflammatory properties and helps maintain the skin's natural barrier function.
  • Fill a bathtub halfway with warm water while adding oatmeal to the bath. Soak in the bathtub for 15-20 minutes.

Treatment options for severe cases include a combination of several of the following:

• Hydration
  • Hospitalization may be required in severe cases.
  • Intravenous fluids and electrolyte replacement are administered to keep the patient hydrated.
• Medications
  • Antibiotics are prescribed to help fight the infection.
  • If necessary, medications for itching, sleep, or anxiety may be prescribed.
• Topical corticosteroids
  • Antiproliferative and immunosuppressive agents may be used with dressings.
  • They come in the form of ointments, creams, lotions, gels, and aerosols. 
• Systemic medications
  • Systemic medications, such as oral corticosteroids, are used to control the condition. While effective, they should be used with caution because sudden withdrawal can exacerbate symptoms.
  • Tumor necrosis factor (TNF)-alpha inhibitors biologics are used to reduce inflammation.

In the early stages of treatment, topical tar treatments and phototherapy should be avoided. Phototherapy should only be used after the skin's redness has subsided.

Most people with erythrodermic psoriasis respond to therapy or a combination of therapies. 

Studies have shown that the mortality rate of people with the condition is 4.6%-64%. However, due to advances in diagnosis and treatment, the number of fatalities is decreasing.