Last reviewed by Editorial Team on August 13th, 2018.
What is Erythrodermic Psoriasis?
This is a rare inflammatory type of psoriasis that affects a majority of your body’s surface. Those who have this type of psoriasis are at risk for developing potentially life-threatening medical conditions like heart failure and pneumonia. This is the least common type of psoriasis.
When a person has this type of psoriasis they are usually hospitalized. When a person gets this type of psoriasis it can occur suddenly without warning or develop gradually. Often people who develop erythrodermic psoriasis have an underlying type of psoriasis called Zumbusch pustular psoriasis which is when you have lesions that form, dry, peel, and then the lesions will re-form. Many people who have erythrodermic psoriasis will develop psoriatic arthritis.
Erythrodermic psoriasis can also appear as your first-ever outbreak of psoriasis. It usually hits adults over the age of fifty and there are more women than men who have this rare form of psoriasis but anyone can get it, even children. In the United States it affects approximately two percent of the people who already have chronic plaque psoriasis.
Erythrodermic Psoriasis Symptoms
When a person has erythrodermic psoriasis at least eighty percent of their skin surface will be extremely red and hot, then starts shedding. Instead of the normal smaller plaque scales that are associated with most types of psoriasis, with this type your skin comes off your body in sheets. When your skin starts to shed, or be continuously scaling, it is often accompanied by severe itching and intense pain. There may even be some swelling. Other symptoms that a person might have can include:
- An elevation in your blood pressure
- Temperature fluctuation
- An elevation in your heart rate
- Hot flashes and chills
Although these are not really symptoms but side effects of the peeling of your skin it is important to know why most are hospitalized with erythrodermic psoriasis. When your skin starts to shed, or peel, the protective function of your skin is lost and leaves your body susceptible to side effects that can be harmful such as:
- Fluid and protein loss that is caused by the fast shedding of your skin in large amounts. This can lead to dehydration and development of a secondary infection.
- Swelling that is caused by fluid retention that is excessive, especially in your ankles
- Lack of control over body temperature that can result in episodes of shivering.
- Viral or bacterial infection that is the result from your inflamed skin. This can sometimes lead to pneumonia.
- Congestive heart failure.
Erythrodermic Psoriasis Causes
Physicians are not exactly sure what the cause of erythrodermic psoriasis is but what they do know is that it is some combination of environment and genes triggers. Some think it is genetic while others think it is caused by a malfunction of your immune system where your healthy cells are mistaken for toxic or diseased cells. This triggers an inflammatory response. Some of the triggers that physicians think could cause an outbreak of erythrodermic psoriasis are:
- Allergic reaction to certain medications like lithium
- The abrupt discontinuation of treatment for systemic psoriasis.
- Injury to your skin
- Excessive exposure to the sunlight
- Having a compromised immune system that is often associated with autoimmune diseases like HIV/AIDS or some cancer therapies
- Lack of humidity in their immediate environment
- Having a low calcium level
- Coal tar based treatments that are often used as a treatment for other types of psoriasis
- Excessive or inappropriate use of corticosteroids
As soon as you have a flare-up or have this fiery red rash and do not know what it is, you should seek medical treatment as soon as possible. When a person has erythrodermic psoriasis there are several different ways that your physician or dermatologist will treat it. Many times treatment will consist of a combination of medications to help control the symptoms along with trying to prevent complications. One such combination is to use systemic psoriasis medications with topical steroidal medications. Using systemic medications is the most effective treatment for erythrodermic psoriasis. The systemic medications can be administered in the form of pills or injections. If you have a severe case of erythrodermic psoriasis you may also receive medications that will suppress your immune system and help to prevent symptom onset. To treat the infection and to help prevent the symptoms from becoming worse and developing complications you may be prescribed antibiotics. Because this is a severe form of psoriasis you may have to have medical interventions that are monitored to help prevent complications and to ensure that the treatments being used are working.
There are some that choose to use phototherapy as a method of treatment but in some cases it can make the symptom of redness worse.
Phototherapy is a medical procedure that uses ultraviolet light to help treat the symptoms. This therapy could also be used in combination with other medication therapies to help heighten your skin sensitivity and promote a successful treatment.
Other things that can be used to help control the symptoms of erythrodermic psoriasis are prescription retinoids, which is a chemical compound that is chemically related to vitamin A to help normalize your skin cell growth and function, specialized shampoos, and moisturizers. Your physician or dermatologist may give you a prescription for anti-itch and pain medications or suggest something you can get over-the-counter for the pain and itching.
You should also make sure that you are keeping your skin clean to help prevent infections. You should also make sure that you are avoiding known triggers to help prevent the onset of symptoms.