Erythrodermic Psoriasis: The Rare and Severe Skin Condition

Introduction:

Psoriasis is a chronic inflammatory skin condition that is proliferative. It is characterized by erythematous plaques covered with silvery scales, especially on the skin of limbs, scalp, and lumbosacral area. This article will explore the pathophysiology, symptoms, and diagnosis of rare Erythrodermic psoriasis and highlight the role of multidisciplinary types of treatment.

What Is Erythrodermic Psoriasis?

Erythrodermic psoriasis is a rare yet dangerous type that causes a red rash over most of the body. Psoriasis is a chronic skin condition that happens when the body produces new skin cells faster than they die. As a result, cells accumulate on the surface of the skin. Erythrodermic psoriasis is uncommon, but it is much more serious than its other subtypes. The rash resembles a severe burn and can be dangerous, increasing the risk of infections, dehydration, chills, heart failure, and other serious health issues. Therefore, erythrodermic psoriasis needs immediate medical attention.

What Causes Erythrodermic Psoriasis?

The erythrodermic type occurs in about 3 % of people with psoriasis. Psoriasis is an autoimmune disease when the body's natural defense system attacks healthy tissue. People with unstable plaque psoriasis are at risk for developing erythrodermic psoriasis. Suddenly stopping psoriasis treatments, such as corticosteroids, can cause erythrodermic psoriasis. Other triggers include:

• Illness or infection.

• Drug reaction.

• Severe sunburn.

• Stress.

• Substance use disorder.

• Alcoholism.

• Human immunodeficiency virus (HIV).

• Overusing medications, such as topical steroids or retinoids (a vitamin A-related drug).

What Are the Symptoms of Erythrodermic Psoriasis?

Erythrodermic psoriasis can occur suddenly (acute rash) in a few days. Mainly, plaques extend from a pre-existing psoriasis rash. Full development of erythrodermic psoriasis can occur gradually over a few months. One may develop redness and inflammation similar to a severe burn or sunburn on a significant part of the body. The skin rash can itch and cause a burning sensation. In addition, there may be peeling skin that comes off in large sheets. Some people can even lose fingernails and toenails. People with erythrodermic psoriasis can develop chills or fever, joint pain, rapid heartbeat, swollen ankles, and other serious health issues. Erythrodermic psoriasis symptoms can develop over time, but they can arrive suddenly, too. Treatments can manage the condition and even put it into remission (minimal rash and symptoms or, sometimes, no rash or symptoms). However, flare-ups can happen with the diffuse rash and symptoms returning.

How Is Erythrodermic Psoriasis Diagnosed?

A healthcare provider often diagnoses erythrodermic psoriasis based on a history of psoriasis and physical examination. The provider also checks for signs of psoriasis, such as plaques, joint pain, and psoriatic nail disease. The provider can order a skin biopsy (a procedure in which a small piece of the skin is removed and checked in the laboratory for signs of psoriasis).

How Is Erythrodermic Psoriasis Treated?

If a person has symptoms of erythrodermic psoriasis, do not wait to get help. Instead, seek medical assistance immediately.

There is no cure for erythrodermic psoriasis, but treatments can reduce and prevent symptoms. Certain flare-up requires urgent medical attention. The healthcare provider may prescribe a combination of one or more of the following drugs:

• Topical ointments like corticosteroids or retinoids.

• Hypoallergenic moisturizers and cool compresses.

• Nonsteroidal anti-inflammatory drugs (NSAIDs).

• Disease-modifying anti-rheumatic drugs (DMARDs).

• Immunosuppressants like Cyclosporine or Methotrexate. These medicines are powerful but can have many side effects. So speak to a healthcare provider first to find out if they are suitable.

Ensure to inform the medical conditions or current medications to the provider, if any.

• Oral retinoids.

• Biologic therapies.

• Antibiotics to help prevent infection.

• Pain medications.

Specific plaque psoriasis treatments can worsen erythrodermic psoriasis. So one should not use the following without first consulting a healthcare provider:

• Oral corticosteroids.

• Coal tar products.

• Phototherapy or light therapy.

How to Prevent Erythrodermic Psoriasis?

Maintaining plaque psoriasis under control with treatments is the most effective way to prevent erythrodermic psoriasis. If someone develops erythrodermic psoriasis, they can take the following steps to avoid a flare-up:

• Limit alcohol.

• Be careful with anything that can irritate the skin.

• Protect skin against sun damage.

• Find healthy ways to manage stress.

• Seek help to quit smoking.

• Never abruptly stop taking psoriasis medication.

• See a healthcare provider regularly.

• Protect and treat wounds to prevent infection.

• Use phototherapy devices carefully to avoid burns.

What Is the Outlook for People With Erythrodermic Psoriasis?

Although erythrodermic psoriasis is a chronic condition without a current cure, it can be well controlled with appropriate treatment. People with erythrodermic psoriasis should follow the healthcare provider's treatment and skincare suggestions to prevent flare-ups. Proper disease management reduces the risk of severe complications and even death.

When to Call a Healthcare Provider?

Call a healthcare provider if one experiences a flare-up or has signs of:

• Excessive peeling of the skin.

• Severely itchy or painful skin.

• Infection, including fever or chills.

• Dehydration.

What Are the Complications of Erythrodermic Psoriasis?

Erythrodermic psoriasis can lead to intense itching or skin pain. The rash can also affect the body's ability to sweat and regulate body temperature. As a result, people may develop hypothermia (low body temperature). Also, it can influence electrolyte levels and lead to dehydration. Some people can also develop a fever, chills, and edema (fluid retention) in their feet and ankles. Sometimes, an infection can occur, but it is not common. The condition is life-threatening around 10 % to 65 % of all cases. Most deaths are associated with infections like pneumonia and staphylococcal septicemia.

Conclusion

Erythrodermic psoriasis is rare among all types of psoriasis. It can cover the entire body with an itchy, scaly rash that can burn intensely. Living with such a chronic skin condition can be challenging and socially distressing. During a flare-up, people can become self-conscious about their appearance. Corticosteroids or other medications, severe sunburn, or another type of psoriasis may trigger the condition. Treatment of erythrodermic psoriasis includes oral prescription medications, topical steroids, and cool compresses. In addition, one might need a combination of therapies and hospital care for severe disease. Call a healthcare provider when a flare-up occurs. Getting the rash under control can lower the risk of serious, potentially life-threatening problems.