Erythrodermic Psoriasis

What is erythrodermic psoriasis?

Erythrodermic psoriasis is a rare skin condition that causes a red rash to form over most of your body. The rash resembles a burn and can be as dangerous as one, causing chills, fever and dehydration. Erythrodermic psoriasis requires immediate medical attention.

What is psoriasis?

Psoriasis is a chronic skin disease that occurs when your body makes new skin cells faster than they slough off, or die. As a result, cells build up on the surface of your skin. Your skin develops thick, itchy, pink or red skin patches with white or silvery scales. This condition (called plaque psoriasis) may look unsightly, but it isn’t a threat to your health.

Erythrodermic psoriasis is a rare type of psoriasis, but it’s much more serious than many other subtypes. The plaques can cover almost your entire body, potentially leading to life-threatening problems.

How common is erythrodermic psoriasis?

Psoriasis affects an estimated 3% of Americans, mostly adults. As many as 9 in 10 people with psoriasis have plaque psoriasis. The erythrodermic type is uncommon, occurring in about 3% of people who have psoriasis.

What causes erythrodermic psoriasis?

Approximately 1 in 3 people who develop erythrodermic psoriasis already have plaque psoriasis. Psoriasis is an autoimmune disease. It happens when your immune system is inappropriately overly active and causes harm to your own body. Inflammation from this reaction causes new skin cells to form too fast.

People with poorly controlled plaque psoriasis are most at risk for developing erythrodermic psoriasis. Abruptly stopping psoriasis treatments, like corticosteroids or immunosuppressants, can cause erythrodermic psoriasis. Overusing medications like topical steroids or retinoids (a vitamin A-related drug) can also cause symptoms.

Some people develop erythrodermic psoriasis after having:

• Allergic reaction to a medication.
• Illness or infection.
• Severe sunburn.
• Stress.
• Substance use disorder.

What are the symptoms of erythrodermic psoriasis?

Erythrodermic psoriasis can come on suddenly (an acute rash) in a couple of days. More commonly, plaques expand from a pre-existing psoriasis rash. Full development of erythrodermic psoriasis may occur gradually over a few months. You develop redness and inflammation that resembles a severe burn or sunburn on more than 90% of your body. The skin rash is very itchy and may cause a burning sensation. You may also develop peeling skin that comes off in large sheets. Some people lose fingernails and toenails.

Erythrodermic psoriasis symptoms can come and go. Treatments can control the condition and even put it into remission, meaning you have minimal rash and symptoms or, sometimes, no rash or symptoms. However, flare-ups can occur with the diffuse rash and symptoms returning.

What are the complications of erythrodermic psoriasis?

Erythrodermic psoriasis may result in significant itching or skin pain. The rash also affects your body’s ability to sweat and regulate your body temperature. You may develop hypothermia (low body temperature). It can affect electrolyte levels and lead to dehydration. You may develop a fever, chills and edema (fluid retention) in your feet and ankles. Sometimes, infection can occur, but it’s not common.

The condition increases your risk for life-threatening problems like:

• Heart failure.
• Infections like septicemia, which can lead to sepsis.
• Pneumonia.

How is erythrodermic psoriasis diagnosed?

A dermatologist diagnoses and treats skin diseases like psoriasis. Your healthcare provider may diagnose the condition based on a previous history of psoriasis, as well as your symptoms. You may get a skin biopsy to confirm the diagnosis.

How is erythrodermic psoriasis treated?

There isn’t a cure for erythrodermic psoriasis, but treatments can minimize and prevent symptoms. A severe flare-up requires immediate medical attention. You may receive care in a hospital.

Erythrodermic psoriasis treatments include:

• Hypoallergenic moisturizers and cool compresses.
• Topical ointments like corticosteroids or retinoids.
• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Immunosuppressants like cyclosporine or methotrexate.
• Disease-modifying antirheumatic drugs (DMARDs).
• Oral retinoids.
• Biologic therapies.

What psoriasis treatments should I avoid?

Certain treatments for plaque psoriasis can worsen erythrodermic psoriasis. You shouldn’t use the following without first consulting your dermatologist:

• Coal tar products.
• Oral corticosteroids.
• Phototherapy that uses ultraviolet (UV) light.

Can you prevent erythrodermic psoriasis?

Keeping plaque psoriasis under control with treatments is the best way to prevent erythrodermic psoriasis.

If you develop erythrodermic psoriasis, you can take these steps to prevent a flare-up:

• Cut back on alcohol.
• Find healthy ways to cope with stress.
• Protect your skin against sun damage.
• Seek help to quit smoking.
• See your dermatologist on a regular basis.

What is the outlook for someone with erythrodermic psoriasis?

Although it can be very well controlled with appropriate treatment, erythrodermic psoriasis is a lifelong condition without a current cure. You’ll need to follow your healthcare provider’s treatment and skincare recommendations to prevent flare-ups. Proper disease management decreases your risk of serious complications and even death.

When should I call the doctor?

Call your healthcare provider if you experience a flare-up or have signs of:

• Dehydration.
• Excessive peeling of skin.
• Infection, including fever or chills.
• Severely itchy or painful skin.

What should I ask my provider?

You may want to ask your healthcare provider:

• What caused erythrodermic psoriasis?
• What’s the best treatment for me?
• What steps can I take to prevent a flare-up or minimize symptoms?
• Should I look for signs of complications?

A note from Cleveland Clinic

Living with a chronic skin condition can be challenging. During a flare-up, you may become self-conscious about your appearance. Your healthcare provider can recommend cosmetics, cleansers and other skin products that won’t irritate sensitive skin. It’s important to follow the prescribed treatment plan to prevent symptoms. Call your healthcare provider when a flare-up happens. Getting the rash under control lowers your risk of serious, potentially life-threatening complications.