Is erythrodermic psoriasis fatal?

What is erythrodermic psoriasis?

• Erythrodermic psoriasis is a rare and severe form of psoriasis that can cover your entire body with a red scaly rash. This type of psoriasis can be very painful and itchy and it can also lead to serious health complications. 
• If you have erythrodermic psoriasis it’s important to see a doctor right away so that you can get the treatment you need.

Causes

• The specific etiology of psoriasis is unknown, however it appears to be caused by an overactive immune system.
• The cause of erythrodermic psoriasis, on the other hand, is unknown.
• Psoriasis patients' bodies create an excessive amount of T-lymphocytes, a type of white blood cell that normally fights infections and viruses.
• These T cells assault healthy skin cells in psoriasis. Overproduction of skin cells, as well as other signs, occur.

Erythrodermic Psoriasis Flare

• The exact causes of erythrodermic psoriasis are unclear, but certain factors can trigger a flare-up.
• These include:
• emotional stress
• infections
• sudden discontinuation of psoriasis treatment
• oral steroid medications
• the use of certain psoriasis treatments
• excessive consumption of alcohol
• overuse of corticosteroids
• sunburn
• allergic reactions and rashes

Symptoms

• Erythrodermic psoriasis symptoms can be intense.
• Early stage mild erythrodermic psoriasis is different among patients: Symptoms may appear suddenly at the onset of a new case of psoriasis, or they may begin gradually during a flare-up of plaque psoriasis.
• Symptoms of erythrodermic psoriasis include:

1. severe skin redness over a large area of ​​the body
2. skin loss that occurs in large sheets rather than small flakes or scales
3. pustules or blisters
4. burnt skin
5. severe itching
6. severe pain
7. increased heart rate
8. fluctuations in body temperature

• These symptoms will affect most people during a flare-up of erythrodermic psoriasis.
• Erythrodermic psoriasis can alter body chemistry. Because of this, people may also experience other symptoms. These include:
• swelling, especially around the ankles
• articular pain
• chills or fever
• Complications
• The skin acts as the body's barrier layer, and it is crucial for overall health.
• The severe skin damage resulting from erythrodermic psoriasis disrupts the entire environment of the body.
• The body becomes susceptible to serious complications, including:
• severe illness due to loss of protein or fluid
• excessive swelling due to fluid retention
• serious infections, including pneumonia and sepsis
• congestive heart failure
• Complications from bacterial infection can become life-threatening

Diagnostic

• Doctors can usually identify erythrodermic psoriasis by doing a physical exam. Most lab tests aren't specific enough to confirm a diagnosis.
• A person who has severe redness and scaling covering 90% of their body will usually be diagnosed with erythrodermic psoriasis.
• The doctor will also check for signs of infection, as severe damage to the skin will make the body vulnerable.
• It is essential that anyone who notices symptoms of erythrodermic psoriasis seek medical attention immediately, as serious and life-threatening complications can occur.
• In some cases, the doctor may admit the person to the hospital.

Treatment

• Erythrodermic psoriasis can be difficult to treat, especially if complications develop.

Topical treatments 

• Topical treatments include:
• topical steroid creams and moisturizers
• wet dressings
• oatmeal baths

Medical treatment

• Emergency treatment is intravenous fluid and electrolyte replacement to treat or prevent dehydration. Some systemic drugs, which affect the whole body, are also available. The doctor may prescribe medication by mouth or administer the medication by injection or infusion.
• Cyclosporine (Neoral) and infliximab (Remicade) are standard first-line treatments for erythrodermic psoriasis.

• The National Psoriasis Foundation Trusted Source medical advisory notes that these seem to be the fastest therapies.

• Some doctors may prescribe methotrexate (Otrexup) or acitretin (Soriatane) instead, but these are slower to work.
• Once a person's condition is stable, the doctor may recommend switching to another drug, possibly etanercept (Enbrel), or using combination therapy.

Biotherapy

• Biologic drugs, such as etanercept or adalimumab (Humira), which are tumor necrosis factor (TNF)-alpha inhibitors, and some interleukin (IL) agents are effective treatments for erythrodermic psoriasis moderate to severe
• New biologics target different genes.

Other treatment

• A doctor may also prescribe antibiotics to prevent or treat other infections if needed.
• The person may need to spend time in the hospital. However, if they are stable and not losing fluids, outpatient treatment may be possible. The person may need bed rest.

People living with HIV

• People living with HIV have a higher risk of developing psoriasis, including erythrodermic psoriasis, and it is likely to be more difficult to treat.
• For someone living with HIV and erythrodermic psoriasis, treatment may start with antiretroviral therapy or ultraviolet (UV) phototherapy.
• After that, the person can be given acitretin. Other treatments may not be effective in treating people with HIV who develop erythrodermic psoriasis.

Prevention

• To prevent an episode of erythrodermic psoriasis, people with psoriasis should follow their prescribed psoriasis routine and avoid specific triggers.
• These may include:
• stress
• cold temperature
• wind
• excessive consumption of alcohol
• smoking

• Sometimes, however, the onset of erythrodermic psoriasis is sudden, making it difficult to avoid potential triggers.