An estimated 7.5 million Americans had psoriasis in 2013, and that number may be even higher today.
Psoriasis affects the body’s immune system, causing it to produce too many skin cells. Those extra cells build up on the skin and create a flaky rash that may appear red, purple, ashen gray, or brown depending on your skin color.
Erythrodermic psoriasis is a very rare type of psoriasis. It affects only about 2 percent of people with psoriasis, according to the National Psoriasis Foundation.
That said, it can be very serious. It typically affects people with unstable plaque psoriasis.
Erythrodermic psoriasis can cause your skin to lose its ability to control your body temperature and protect you against infections. If your body can’t keep itself warm, you could develop hypothermia.
That’s why this condition is considered a medical emergency that needs immediate care, usually in a hospital.
The main symptom of erythrodermic psoriasis in people with light skin is a deep red rash all over your body. In People of Color, a rash may be other colors such as purple or gray.
Other symptoms include:
- shedding of the skin in sheets instead of smaller scales
- burned-looking skin
- fast heart rate
- severe pain and itching
- body temperature that goes up and down, especially on hot and cold days
Erythrodermic psoriasis doesn’t just affect your skin. It also can affect the balance of chemicals in your body and lead to body temperature shifts.
Your body might hold onto extra fluid and swell up — especially your ankles. In severe cases, this form of psoriasis can cause pneumonia or heart failure.
Though this may sound scary, treatment for erythrodermic psoriasis is available and discussed in greater detail below.
Doctors don’t know exactly what causes this type of psoriasis.
One theory is that it stems from the immune system reaction that causes the body to overproduce chemicals that promote inflammation. Genetics may also be involved.
Most people with erythrodermic psoriasis start out with another type of psoriasis, a skin disorder like eczema, or a type of lymphoma that affects the skin.
You might first notice that your skin isn’t getting better with treatment — or even that it’s getting worse. Sometimes a reaction to a medication or stopping steroids abruptly can trigger this condition.
Erythrodermic psoriasis can disrupt your body’s fluid balance and temperature regulation. This could lead to complications like:
- swelling under the skin, especially in the lower legs and feet, from fluid buildup (edema)
- heart failure
A dermatologist may be able to diagnose erythrodermic psoriasis just by examining you. Signs of this condition include:
- redness or other discoloration like purple, gray, or brown patches depending on your skin color
The discoloration could potentially cover
Your doctor can remove a small piece of your skin to look for higher-than-normal levels of white blood cells and other substances related to erythrodermic psoriasis.
A blood test may show:
- a high white blood cell count
- a low red blood cell count (anemia)
- atypical electrolyte levels
- markers of inflammation, such as C-reactive protein
Because erythrodermic psoriasis is a medical emergency, the first step is to call 911 or get to an emergency room. There, they’ll restore your body temperature, fluids, and electrolyte balance to their usual levels. You’ll also get medications to treat symptoms.
You may need to get treatments such as intravenous (IV) fluids and electrolytes in a hospital until you are stable.
There, you may also get treatments for any complications. For example, antibiotics treat infections and diuretics release excess fluid from your body.
A healthcare professional may apply steroid cream to your skin, then cover it with a dressing of wet gauze to help your skin heal. They may also suggest applying a moisturizing cream to soften your skin and reduce scaling.
Taking a warm bath or oatmeal bath might help you feel more comfortable.
A few medications that you take by mouth treat erythrodermic psoriasis, including:
- biologic drugs, such as:
- etanercept (Enbrel)
- golimumab (Simponi)
- infliximab (Remicade)
- ixekizumab (Taltz)
- secukinumab (Cosentyx)
- ustekinumab (Stelara)
- cyclosporine, an anti-rejection drug that dampens the immune response that causes psoriasis
- acitretin (Soriatane)
All of these medicines can have side effects, some of which can be serious. It’s important to keep in close touch with your doctor while you take them.
Phototherapy, a treatment that uses ultraviolet (UV) light, is another way to help relieve symptoms. The UV light helps reduce inflammation and potentially slows new skin cell growth.
It’s best to see a dermatologist who has experience treating erythrodermic psoriasis.
They may give you a combination of oral and topical medications. Combining a few different medications may work better than taking a single drug alone.
You may also need medications to:
- relieve pain
- help you sleep
- control the itch
- clear up a skin infection
Erythrodermic psoriasis triggers can include:
- severe sunburn
- emotional stress
- going off steroids too quickly
- a reaction to medications such as lithium or interleukin II (IL-2)
- alcohol use
To prevent erythrodermic psoriasis, follow the psoriasis treatment plan your dermatologist or doctor recommends. Try to avoid stress and other known psoriasis triggers.
If your skin starts to get worse, speak with your doctor for a medication adjustment. In severe cases, it may be necessary to call 911 or go to an emergency room for treatment.
Treating erythrodermic psoriasis can involve a lot of trial and error. You may have to try a few different drugs or a combination of medications and lifestyle remedies to find the treatment that works best for you.
You’ll most likely need to keep taking medications over the long term to keep your symptoms under control. Your doctor can help you find an effective treatment plan to improve your quality of life.
One of the best ways to deal with erythrodermic psoriasis is to try to prevent flare-ups. Avoid potential triggers such as sunburns, infections, and stress whenever possible.