Symptoms of this chronic autoimmune disease are severe and can cause damage to skin, hair, and nails. In some cases, it can cause fever, chills, fatigue, heart failure, and bacterial infection caused by Staphylococcus aureus.
What are the symptoms of erythrodermic psoriasis?
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
- 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.
What can trigger erythrodermic psoriasis?
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
- 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
What are treatment options for erythrodermic psoriasis?
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
How is severe erythrodermic psoriasis treated?
Treatment options for severe cases include a combination of several of the following:
- Hospitalization may be required in severe cases.
- Intravenous fluids and electrolyte replacement are administered to keep the patient hydrated.
- 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.
What is the prognosis for erythrodermic psoriasis?
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.
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Langmaid S. Erythrodermic Psoriasis. WebMD. https://www.webmd.com/skin-problems-and-treatments/psoriasis/erythrodermic-psoriasis
Singh RK, Lee KM, Ucmak D, et al. Erythrodermic psoriasis: pathophysiology and current treatment perspectives. Psoriasis (Auckl). 2016;6:93-104. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5572467/
National Psoriasis Foundation. Erythrodermic Psoriasis. https://www.psoriasis.org/erythrodermic-psoriasis/
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