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Erythrodermic psoriasis

Published by Bupa's health information team, September 2008.

This factsheet is for people who have had erythrodermic psoriasis, or who would like information about it.

Psoriasis is a common skin condition causing patches of inflamed skin. Erythrodermic psoriasis is a rare, severe form of the condition, in which your skin becomes red and inflamed all over. It usually needs to be treated in hospital.

About erythrodermic psoriasis

In psoriasis, the rate at which your skin is replaced is greatly increased.

Your skin is constantly shedding old cells and being replaced with new ones from underneath, in a cycle that usually takes about 28 days. In psoriasis, this process speeds up, only taking about three to four days. New skin cells move rapidly to the surface before they have properly matured, forming thick patches called plaques. There is also a build-up of a type of white blood cell (called T-cells) under the skin, which causes inflammation.

In erythrodermic psoriasis, your skin becomes severely inflamed - this spreads over your entire body. This intense inflammation of your skin results in protein and fluid loss, which can lead to serious, life-threatening illness. Erythrodermic psoriasis usually only develops in people who already have an ongoing form of psoriasis - it is unlikely to appear in people who have no history of the condition.

Erythrodermic psoriasis often happens in combination with pustular psoriasis (see related topics).

Symptoms of erythrodermic psoriasis

You may get the following symptoms if you have erythrodermic psoriasis:

  • very hot, reddened skin over most of your body
  • shedding of your skin
  • severe itching
  • your skin may feel painful
  • swelling of your ankles
  • fever
  • shivering

You should seek immediate medical attention if you get these symptoms.

Complications of erythrodermic psoriasis

Erythrodermic psoriasis affects the skin over your whole body. This can have an effect on your whole body, leading to problems such as:

  • heart failure
  • infection
  • very low body temperature (hypothermia)
  • dehydration
  • capillary leak syndrome - a condition where fluid leaks out of your blood vessels; this can cause serious problems in your lungs

Causes of erythrodermic psoriasis

It is thought that substances produced by your immune system cause your skin to start producing new cells faster in psoriasis, as well as causing the build up of T-cells.

Certain factors may trigger the development of erythrodermic psoriasis, including:

  • suddenly stopping treatment with certain medicines for psoriasis
  • oral steroids (these may be used to treat some types of psoriasis)
  • an allergy to other medicines
  • severe sunburn

Diagnosis of erythrodermic psoriasis

If you go to your GP because of symptoms affecting your skin, he or she will examine you and ask about your symptoms. Your GP will refer you to a dermatologist as an emergency if you have symptoms of erythrodermic psoriasis. A dermatologist is a doctor specialising in conditions affecting the skin.

In hospital, the dermatologist will examine you and may carry out some tests, such as taking a skin biopsy (a small sample of your skin) to check that your symptoms are caused by psoriasis. You will only be diagnosed as having erythrodermic psoriasis if you have a history of psoriasis and the inflamed skin extends over more than 90 percent of your body surface area.

Treatment of erythrodermic psoriasis

You may need to stay in hospital until you recover from erythrodermic psoriasis. While in hospital, nurses will monitor your pulse rate, blood pressure, temperature, breathing and fluid levels. You will be given emollients (moisturisers) to keep your skin moist and reduce the irritation.

Medicines

You may be given the following medicines while in hospital for generalised pustular psoriasis.

  • Medicated topical preparations (treatments that are applied directly to the skin), such as steroid creams.
  • Oral medicines (medicines that you take by mouth), such as acitretin, ciclosporin and methotrexate tablets. These medicines can have various uncommon side-effects, which will be discussed with you before they are prescribed. You will also need various pre-treatment tests and blood test monitoring throughout treatment.
  • New biological agents, such as infliximab. These agents can be very effective, but tend to be restricted to people with the most severe type of disease. Your dermatologist can discuss these treatments with you. You will also need various pre-treatment tests and blood test monitoring with these agents.

Light therapy

Once the severe stage of your psoriasis has passed and the inflammation has died down, you may also be offered one of the following light therapies:

  • Ultraviolet B (UVB) light therapy. UVB light occurs naturally in sunlight. This therapy involves shining artificial UVB light onto your skin. You will usually have the therapy two to three times a week for several weeks.
  • Psoralen and ultraviolet A light treatment (also called PUVA). This involves combining a medicine which sensitises the skin to sunlight (psoralen) with a controlled dose of ultraviolet A (UVA) light. You may have psoralen as a tablet or applied directly to your skin. The UVA light is given in a machine that looks similar to a shower cabinet, containing fluorescent tubes. You usually have the treatment twice a week, for several weeks.

Prevention of erythrodermic psoriasis

You can reduce your chance of having another episode of erythrodermic psoriasis by ensuring you use any treatment you have been given for psoriasis as prescribed. If you notice your psoriasis worsening, see your doctor without delay. Some types of medicine can provoke erythrodermic psoriasis; however, you should not stop taking any treatment without advice from your doctor.

Further information

Related topics

Sources

  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2005:646-647
  • Erythrodermic psoriasis. National Psoriasis Foundation. www.psoriasis.org, accessed 9 June 2008
  • Kumar P, Clark M. Clinical Medicine. 6th ed. London: Elsevier, 2005: 1340-1341
  • Joint Formulary Committee, British National Formulary. 54 ed. British Medical Association and Royal Pharmaceutical Society of Great Britain. 2007:603-610
  • Guidelines for the general management of psoriasis. British Association of Dermatologists. www.bad.org.uk, accessed 29 May 2008
  • Treatments for moderate or severe psoriasis. British Association of Dermatologists. www.bad.org.uk, accessed 4 June 2008
  • Systemics. The Psoriasis Association. www.psoriasis-association.org.uk, accessed 11 June 2008
  • Smith CH, Anstey A, Barker J, et al. British Association of Dermatologists guidelines for use of biological interventions in psoriasis 2005. British J Dermatology 2005;153:486-497

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Mike Ardern-Jones, BSc, MBBS, MRCP, DPhil, Consultant Dermatologist, Southampton University NHS Trust and Spire Southampton Hospital, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: September 2008

 

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