Erythrodermic Psoriasis: Important Facts You Should Know

By Leah Campbell
Reviewed by Allison Truong, M.D.
July 03, 2023

Most forms of psoriasis are uncomfortable but manageable. Yet, for the small percentage of psoriasis patients who develop erythrodermic psoriasis, it can make them pretty sick and usually requires a trip to the hospital for close monitoring. So, it’s good idea for everyone with psoriasis to understand this condition. That way, you would know what to do if you develop it—and learn ways to possibly prevent it.

What Is Erythrodermic Psoriasis?

Erythrodermic psoriasis is a severe form of psoriasis that can be life-threatening. With it, people experience redness and a peeling of the skin of nearly the entire body that can be painful and extremely itchy, says Brooke Jeffy, M.D., a board-certified dermatologist in Phoenix, Arizona.

“This severe form of psoriasis can also be associated with fever, chills, rapid heart rate, and enlarged lymph nodes,” says Jeffy. “Fortunately, it is rare.”

It presents in around 1 to 2 percent of people with psoriasis, according to a study published in Psoriasis: Targets and Therapy.

According to the National Psoriasis Foundation, one of the markers of erythrodermic psoriasis is that it often covers the entire body, disrupting the normal body temperature and fluid balance. This can result in shivering, swelling of the feet and ankles, and a higher risk of infection and heart failure.

“Erythrodermic psoriasis is potentially life-threatening due to changes in blood flow that lead to the rash and can cause cardiac, renal, and pulmonary complications,” says Jeffy.

How Is It Different from Other Types of Psoriasis?

Erythrodermic psoriasis is different from the other, more common types of psoriasis in how it looks, the way it develops, and the risks it poses.

The study mentioned above categorized erythrodermic psoriasis as being present when at least 75 percent of the body is involved. “The other forms of psoriasis do not tend to cover so much of the skin surface,” Jeffy says.

Erythrodermic psoriasis is often triggered by something such as an allergic reaction, infection, severe sunburn, medication, stress, or alcohol use. It may also be a person’s first presentation with psoriasis or a sign of worsening psoriasis, says Anna H. Chacon, M.D., a board-certified dermatologist at the Cleveland Clinic Florida, Weston Hospital.

“Erythroderma can occur more acutely, over a period of several days, or it can occur over several months on a more gradual basis,” says Chacon.

Who Gets Erythrodermic Psoriasis?

While the number of people with psoriasis who develop erythroderma is very low, the condition is not so rare that dermatologists don’t still see cases from time to time, says Chacon.

“It usually presents when a patient’s psoriasis is poorly controlled or unstable, and is more commonly seen in an inpatient or hospital setting,” says Chacon.

Jeffy says male patients ages 40 to 60 seem most commonly affected. “However, due to the rarity of this condition, the demographics are not entirely clear.”

What Are the Treatments for Erythrodermic Psoriasis?

If you have this type of psoriasis, it’s important to get your fluid balance and body temperature back to normal, usually in a hospital setting. Jeffy says your vital signs should be closely monitored and that you should be watched for infections that can occur when the skin barrier is compromised.

“Hospitalization may be needed for this monitoring, or to provide intravenous fluids,” she says. It’s also important you receive a systemic psoriasis treatment to control the inflammation.

“The most common initial treatment is cyclosporine, because it works quickly,” says Jeffy.

“The newer biologic therapies for psoriasis have had great success at getting patients back on their feet,” adds Chacon.

Your treatment will likely also include emollients and wet dressings to keep the skin hydrated, bed rest, and treatment of any infections or other complications you have.

What Should I Do If I Think I Have Erythrodermic Psoriasis?

Erythrodermic psoriasis can be very dangerous, so if you suspect you have it, seek medical care immediately, says Jeffy.

The National Psoriasis Foundation urges people with psoriasis to seek medical attention right away if they experience the following symptoms:

  • A large area of skin shedding
  • Skin coming off in sheets instead of scales
  • Sustained increase in heart rate
  • Fluctuating body temperature
  • The appearance of burned skin
  • Severe skin pain

“Ideally, it is best to avoid getting into an erythrodermic state, as patients are often unstable,” says Chacon. “The best-case scenario is to have the underlying condition well controlled, so that erythroderma does not arise in the first place.”

Controlling your psoriasis means keeping up with your routine doctor’s appointments and prescribed treatments. That way, you may prevent your condition from ever reaching the point of erythrodermic psoriasis. However, if your condition does progress, don’t hesitate to reach out for medical help immediately.

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