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Erythrodermic psoriasis in adults

Authors
Jason E Hawkes, MD
Kristina Callis Duffin, MD
Section Editor
Jeffrey Callen, MD, FACP, FAAD
Deputy Editor
Abena O Ofori, MD

INTRODUCTION

Erythrodermic psoriasis is an uncommon, severe variant of psoriasis that is characterized by widespread erythema of the skin. Patients with this psoriasis subtype typically present with erythema involving more than 75 percent of the body surface area and associated scale, pustules, or exfoliation of the skin (picture 1A-C).

Recognition of this potentially life-threatening form of psoriasis is imperative. A detailed history and thorough evaluation of the patient are necessary to establish a diagnosis and rule out conditions that closely mimic erythrodermic psoriasis. (See "Erythroderma in adults" and "Neonatal and infantile erythroderma".)

The clinical manifestations, diagnosis, and management of erythrodermic psoriasis will be discussed here. Other variants of psoriasis are reviewed separately.

(See "Epidemiology, clinical manifestations, and diagnosis of psoriasis".)

(See "Treatment of psoriasis".)

                            

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Literature review current through: Apr 2017. | This topic last updated: Feb 27, 2017.
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References
Top
  1. Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol 2014; 70:512.
  2. Lebwohl M. Psoriasis. Lancet 2003; 361:1197.
  3. Boyd AS, Menter A. Erythrodermic psoriasis. Precipitating factors, course, and prognosis in 50 patients. J Am Acad Dermatol 1989; 21:985.
  4. Xing X, Liang Y, Sarkar MK, et al. IL-17 Responses Are the Dominant Inflammatory Signal Linking Inverse, Erythrodermic, and Chronic Plaque Psoriasis. J Invest Dermatol 2016; 136:2498.
  5. Zhang P, Chen HX, Duan YQ, et al. Analysis of Th1/Th2 response pattern for erythrodermic psoriasis. J Huazhong Univ Sci Technolog Med Sci 2014; 34:596.
  6. Abdallah MA, Abdel-Hamid MF, Kotb AM, Mabrouk EA. Serum interferon-gamma is a psoriasis severity and prognostic marker. Cutis 2009; 84:163.
  7. Moy AP, Murali M, Kroshinsky D, et al. Immunologic Overlap of Helper T-Cell Subtypes 17 and 22 in Erythrodermic Psoriasis and Atopic Dermatitis. JAMA Dermatol 2015; 151:753.
  8. Rosenbach M, Hsu S, Korman NJ, et al. Treatment of erythrodermic psoriasis: from the medical board of the National Psoriasis Foundation. J Am Acad Dermatol 2010; 62:655.
  9. Shmidt E, Wetter DA, Ferguson SB, Pittelkow MR. Psoriasis and palmoplantar pustulosis associated with tumor necrosis factor-α inhibitors: the Mayo Clinic experience, 1998 to 2010. J Am Acad Dermatol 2012; 67:e179.
  10. Goiriz R, Daudén E, Pérez-Gala S, et al. Flare and change of psoriasis morphology during the course of treatment with tumour necrosis factor blockers. Clin Exp Dermatol 2007; 32:176.
  11. Esposito M, Saraceno R, Schipani C, et al. Trimethoprim-sulfamethoxazole induced erythrodermic psoriasis. J Infect 2008; 57:90.
  12. Cox NH, Gordon PM, Dodd H. Generalized pustular and erythrodermic psoriasis associated with bupropion treatment. Br J Dermatol 2002; 146:1061.
  13. Lemmenmeier E, Gaus B, Schmid P, Hoffmann M. A case of erythrodermia from exacerbated psoriasis vulgaris due to treatment of acute hepatitis C. BMC Dermatol 2016; 16:5.
  14. Morar N, Willis-Owen SA, Maurer T, Bunker CB. HIV-associated psoriasis: pathogenesis, clinical features, and management. Lancet Infect Dis 2010; 10:470.
  15. Saraceno R, Talamonti M, Galluzzo M, et al. Ustekinumab treatment of erythrodermic psoriasis occurring after physical stress: a report of two cases. Case Rep Dermatol 2013; 5:254.
  16. Burden AD, Muston H, Beck MH. Intolerance and contact allergy to tar and dithranol in psoriasis. Contact Dermatitis 1994; 31:185.
  17. Pagliaro JA, Jones SK. Recurrent erythrodermic psoriasis in a thiuram-allergic patient due to contact with nurses' rubber gloves. Br J Dermatol 1999; 140:567.
  18. Preiss JC, Zouboulis CC, Zeitz M, Duchmann R. [Severe erythrodermic psoriasis in a patient with 22q11 deletion syndrome]. Med Klin (Munich) 2005; 100:275.
  19. Guerreiro de Moura CA, de Assis LH, Góes P, et al. A Case of Acute Generalized Pustular Psoriasis of von Zumbusch Triggered by Hypocalcemia. Case Rep Dermatol 2015; 7:345.
  20. Stewart AF, Battaglini-Sabetta J, Millstone L. Hypocalcemia-induced pustular psoriasis of von Zumbusch. New experience with an old syndrome. Ann Intern Med 1984; 100:677.
  21. Strober BE, Clay Cather J, Cohen D, et al. A Delphi Consensus Approach to Challenging Case Scenarios in Moderate-to-Severe Psoriasis: Part 2. Dermatol Ther (Heidelb) 2012; 2:2.
  22. Nicolis GD, Helwig EB. Exfoliative dermatitis. A clinicopathologic study of 135 cases. Arch Dermatol 1973; 108:788.
  23. Tomasini C, Aloi F, Solaroli C, Pippione M. Psoriatic erythroderma: a histopathologic study of forty-five patients. Dermatology 1997; 194:102.
  24. Akhyani M, Ghodsi ZS, Toosi S, Dabbaghian H. Erythroderma: a clinical study of 97 cases. BMC Dermatol 2005; 5:5.
  25. Sigurdsson V, Toonstra J, Hezemans-Boer M, van Vloten WA. Erythroderma. A clinical and follow-up study of 102 patients, with special emphasis on survival. J Am Acad Dermatol 1996; 35:53.
  26. SHUSTER S. High-output cardiac failure from skin disease. Lancet 1963; 1:1338.
  27. Voigt GC, Kronthal HL, Crounse RG. Cardiac output in erythrodermic skin disease. Am Heart J 1966; 72:615.
  28. Kanthraj GR, Srinivas CR, Devi PU, et al. Quantitative estimation and recommendations for supplementation of protein lost through scaling in exfoliative dermatitis. Int J Dermatol 1999; 38:91.
  29. FOX RH, SHUSTER S, WILLIAMS R, et al. CARDIOVASCULAR, METABOLIC, AND THERMOREGULATORY DISTURBANCES IN PATIENTS WITH ERYTHRODERMIC SKIN DISEASES. Br Med J 1965; 1:619.
  30. Green MS, Prystowsky JH, Cohen SR, et al. Infectious complications of erythrodermic psoriasis. J Am Acad Dermatol 1996; 34:911.
  31. McGregor JM, Barker JN, MacDonald DM. Pulmonary capillary leak syndrome complicating generalized pustular psoriasis: possible role of cytokines. Br J Dermatol 1991; 125:472.
  32. Sadeh JS, Rudikoff D, Gordon ML, et al. Pustular and erythrodermic psoriasis complicated by acute respiratory distress syndrome. Arch Dermatol 1997; 133:747.
  33. Management of erythrodermic psoriasis with low-dose cyclosporin. Studio Italiano Multicentrico nella Psoriasi (SIMPSO). Dermatology 1993; 187 Suppl 1:30.
  34. Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol 2009; 61:451.
  35. Viguier M, Pagès C, Aubin F, et al. Efficacy and safety of biologics in erythrodermic psoriasis: a multicentre, retrospective study. Br J Dermatol 2012; 167:417.
  36. Lewis TG, Tuchinda C, Lim HW, Wong HK. Life-threatening pustular and erythrodermic psoriasis responding to infliximab. J Drugs Dermatol 2006; 5:546.
  37. Rongioletti F, Borenstein M, Kirsner R, Kerdel F. Erythrodermic, recalcitrant psoriasis: clinical resolution with infliximab. J Dermatolog Treat 2003; 14:222.
  38. Takahashi MD, Castro LG, Romiti R. Infliximab, as sole or combined therapy, induces rapid clearing of erythrodermic psoriasis. Br J Dermatol 2007; 157:828.
  39. Poulalhon N, Begon E, Lebbé C, et al. A follow-up study in 28 patients treated with infliximab for severe recalcitrant psoriasis: evidence for efficacy and high incidence of biological autoimmunity. Br J Dermatol 2007; 156:329.
  40. Geiger JM, Czarnetzki BM. Acitretin (Ro 10-1670, etretin): overall evaluation of clinical studies. Dermatologica 1988; 176:182.
  41. Muchenberger S, Schöpf E, Simon JC. The combination of oral acitretin and bath PUVA for the treatment of severe psoriasis. Br J Dermatol 1997; 137:587.
  42. Nast A, Sporbeck B, Rosumeck S, et al. Which antipsoriatic drug has the fastest onset of action? Systematic review on the rapidity of the onset of action. J Invest Dermatol 2013; 133:1963.
  43. Pescitelli L, Dini V, Gisondi P, et al. Erythrodermic psoriasis treated with ustekinumab: an Italian multicenter retrospective analysis. J Dermatol Sci 2015; 78:149.
  44. Saeki H, Nakagawa H, Ishii T, et al. Efficacy and safety of open-label ixekizumab treatment in Japanese patients with moderate-to-severe plaque psoriasis, erythrodermic psoriasis and generalized pustular psoriasis. J Eur Acad Dermatol Venereol 2015; 29:1148.
  45. Lee WK, Kim GW, Cho HH, et al. Erythrodermic Psoriasis Treated with Golimumab: A Case Report. Ann Dermatol 2015; 27:446.
  46. Heikkilä H, Ranki A, Cajanus S, Karvonen SL. Infliximab combined with methotrexate as long-term treatment for erythrodermic psoriasis. Arch Dermatol 2005; 141:1607.
  47. Mallon E, Bunker CB. HIV-associated psoriasis. AIDS Patient Care STDS 2000; 14:239.
  48. Menon K, Van Voorhees AS, Bebo BF Jr, et al. Psoriasis in patients with HIV infection: from the medical board of the National Psoriasis Foundation. J Am Acad Dermatol 2010; 62:291.
  49. Chiricozzi A, Saraceno R, Cannizzaro MV, et al. Complete resolution of erythrodermic psoriasis in an HIV and HCV patient unresponsive to antipsoriatic treatments after highly active antiretroviral therapy (Ritonavir, Atazanavir, Emtricitabine, Tenofovir). Dermatology 2012; 225:333.
  50. Masson C, Chennebault JM, Leclech C. Is HIV infection contraindication to the use of methotrexate in psoriatic arthritis? J Rheumatol 1995; 22:2191.
  51. Maurer TA, Zackheim HS, Tuffanelli L, Berger TG. The use of methotrexate for treatment of psoriasis in patients with HIV infection. J Am Acad Dermatol 1994; 31:372.