Erythrodermic psoriasis affects an estimated 1 percent to 2.25 percent of people living with psoriasis. The condition is associated with considerable risk for severe health outcomes, including infection, heart failure, and death.

In this article, we will discuss the symptoms and diagnosis of erythrodermic psoriasis, as well as treatment options.

Symptoms of Erythrodermic Psoriasis

Erythrodermic psoriasis shares many of the same symptoms as other types of psoriasis. People with erythrodermic psoriasis may experience scaly, silver plaques, itchiness, pain, and skin irritation. However, in other forms of psoriasis, like plaque psoriasis, these lesions tend to have well-defined borders and are typically located around the elbows, knees, and scalp. People with erythrodermic psoriasis usually have more extensive or severe symptoms that affect large areas of the body.

Erythroderma is thought to be caused by excessive immune system activity resulting in skin inflammation, and it can be life-threatening. Generally speaking, one-third of erythroderma cases are caused by psoriasis, while the remaining cases are attributable to a variety of skin conditions and other illnesses.

Erythroderma

The defining feature of erythrodermic psoriasis is erythroderma, or inflammatory reddening of the skin that covers more than 75 percent of your body. In erythrodermic psoriasis, the widespread reddening of the skin is also accompanied by significant exfoliation and scaling. The National Psoriasis Foundation further notes that your skin may peel in large sheets and appear sunburned.

Nail Psoriasis

Individuals with erythrodermic psoriasis may also experience nail psoriasis. Common symptoms of nail psoriasis include:

• Pitting
• Onycholysis (separation of the nail from the nail bed)
• Subungual hyperkeratosis (excessive accumulation of skin cells under the nail)
• Oil spots (yellowing of the nail due to immature keratin)
• Other nail abnormalities

Pustules

Pustules are another symptom sometimes associated with erythrodermic psoriasis. Pustules, or pus-filled blisters, are classically seen with pustular psoriasis, but people with erythrodermic psoriasis may experience them as well.

Systemic Symptoms

Notably, people with erythrodermic psoriasis may also have:

• Fever or chills
• An appearance of illness
• Joint pain
• Lymph node swelling
• Dehydration

As the disease progresses, life-threatening bacterial infections, including pneumonia and sepsis, can arise. Individuals with other chronic conditions, including HIV, may be at higher risk for these severe outcomes. Heart failure may also occur in people with erythrodermic psoriasis.

Ultimately, these dangerous symptoms may result in hospitalization and death. While estimates vary greatly, a study from 2017 found that erythrodermic psoriasis was lethal in approximately 30 percent of individuals. The seriousness of erythrodermic psoriasis sets it apart from other types of psoriasis, which tend to be more chronic.

Diagnosis of Erythrodermic Psoriasis

Diagnosing erythrodermic psoriasis typically requires a comprehensive history and physical exam. Your dermatologist or other health care provider may ask you if you have a history of psoriasis because erythrodermic psoriasis is often a sign of poorly controlled or worsening psoriasis.

You may also be asked if you were recently sick or if you made any changes to your medications recently. Both of these can be triggers for erythrodermic psoriasis, so the information can help lead to a diagnosis. Your provider will then perform a physical exam to determine if you have widespread skin discoloration (e.g., red, brown, or purple, depending on your skin tone), scaling, exfoliation, or other psoriasis symptoms including nail psoriasis and psoriatic arthritis.

Erythrodermic psoriasis is not the only cause of erythroderma, so your doctor will want to rule out other possible causes. Additional causes include:

• Other skin conditions, such as eczema, or blistering diseases
• Reactions to medications
• Cancer
• Sezary syndrome, a type of cutaneous T-cell lymphoma

Your doctor may perform a skin biopsy to help diagnose your condition. Dermatologists may remove a small portion of your skin to examine it under a microscope. They will then look for the defining characteristics of erythrodermic psoriasis, which include features specific to both erythroderma and psoriasis. An accurate diagnosis of erythrodermic psoriasis is critical to effective management of the disease.

Erythrodermic Psoriasis Treatment

Erythrodermic psoriasis can be difficult to treat, and sometimes hospitalization is required to administer fluids and bring down fever. Treatment options include topical medications (moisturizers and ointments), oral medications, and biologics.

Your doctor may recommend the immunosuppressive drugs methotrexate or cyclosporine, or the oral retinoid acitretin. Your doctor may prescribe biologics such as adalimumab (Humira), etanercept (Enbrel), and ustekinumab (Stelara) to treat erythrodermic psoriasis.

Oral steroids are generally not recommended due to possible complications but may be used if other treatments are not successful.

Talk With Others Who Understand

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