What To Know about Erythrodermic Psoriasis

Medically reviewed by Brendan Camp, MDMedically reviewed by Brendan Camp, MD

Erythrodermic psoriasis (EP) is a rare form of psoriasis. Psoriasis is a chronic (long-term) autoimmune skin condition that causes the body to produce new skin cells too quickly. This leads to a build-up of old skin cells on the surface of the skin and causes thick, itchy patches of skin. About 2% of people with psoriasis develop erythrodermic psoriasis.

Erythrodermic psoriasis is serious and may be life-threatening. It causes redness and swelling in the skin that looks like a burn. This type of psoriasis covers at least 75% of the body.

Erythrodermic psoriasis affects the body’s temperature regulation and fluid balance. It is considered a medical emergency and requires immediate treatment. There is no cure for psoriasis, but treatment options are available to manage the EP symptoms. 

Types of Psoriasis

Erythrodermic psoriasis is a rare form of psoriasis, an autoimmune condition that causes the skin cells to multiply too quickly. Autoimmune conditions develop when the body mistakenly attacks healthy cells—in this case, skin cells.

More common types of psoriasis include:

• Plaque psoriasis: The most common type of psoriasis with symptoms like red, raised patches covered by silvery-white scales

• Guttate psoriasis: More common in children and young adults, presenting as small red dots on the skin

• Pustular psoriasis: Pus-filled bumps surrounded by red skin

• Inverse psoriasis: Smooth, red patches in the folds of the skin 
  

Erythrodermic Psoriasis Symptoms

Erythrodermic psoriasis causes severe skin symptoms, as well as systemic symptoms that affect the entire body.

Skin Symptoms

Erythrodermic psoriasis causes a rash that covers at least 75% of the body. The rash usually appears red on lighter skin tones and purple or gray on darker skin tones. Other symptoms include:

• Inflammation

• Severe burn resemblance

• Burning

• Pain

• Peeling

• Shedding sheets of skin (as opposed to smaller scales)

Systemic Symptoms

Erythrodermic psoriasis affects the body’s ability to regulate temperature and balance fluids. This can lead to severe symptoms like:

• Edema (swelling) in the hands or feet

• Fever, chills, and shivering

• Body temperature changes

• Tachycardia (fast heart rate)

Causes

Psoriasis is an autoimmune disease that occurs when the immune system overreacts. This reaction leads to inflammation, which causes the skin cells to over-proliferate (multiply too quickly) and build up into plaques or scales.

Researchers do not know the exact cause of erythrodermic psoriasis. People with other types of psoriasis are at an increased risk of developing EP. Suddenly stopping psoriasis treatments like corticosteroids or immunosuppressants can also trigger it.

Risk Factors

Certain lifestyle and health factors raise the risk of erythrodermic psoriasis, including:

• Uncontrolled plaque psoriasis

• History of a severe sunburn 

• Skin infection

• Significant emotional stress

• Alcohol use disorder
  

Diagnosis

Erythrodermic psoriasis is a serious health condition, and it’s important to see your healthcare provider as soon as you develop symptoms. Your primary healthcare provider (PCP) will likely refer you to a dermatologist (a medical doctor who specializes in skin conditions).

In addition to taking your medical history and performing a physical exam, your dermatologist may perform the following diagnostic tests:

• Blood tests: Complete blood count (CBC), electrolyte levels, and inflammation markers

• Skin biopsy: Taking a small skin sample and inspecting it under a microscope to evaluate the type of reaction happening within the skin

What Are Electrolytes?

Electrolytes are electrically charged minerals (such as sodium, potassium, and chloride) in blood, sweat, and urine. They help regulate the nervous system, hydration, muscle function, and blood pH (acidity).

Erythrodermic Psoriasis Treatment

Erythrodermic psoriasis is a medical emergency that requires immediate medical attention. If you develop a severe rash that covers most of your body, seek care in the emergency department. Emergency treatment may include:

• Intravenous (IV) fluids to treat dehydration 

• IV electrolytes to improve electrolyte imbalance

• Steroid cream covered with wet gauze to soothe pain and itching

• Moisturizing cream to soften the skin

Once the condition stabilizes, your healthcare team will work to develop a long-term treatment plan to manage your symptoms.

Long-term treatment options for EP include:

• Biologics (medications that are manufactured or derived from living or biological sources) like Enbrel (etanercept)

• Retinoids (vitamin A-based products) like Soriatane (acitretin)

• Immunosuppressants like cyclosporine and methotrexate

Other treatment options include:

• Phototherapy (ultraviolet, or UV, light to reduce inflammation, itching, and pain)

• Moisturizers and cool compresses

• Non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen)
  

Prevention

It's unclear what causes erythrodermic psoriasis, so it is not always possible to prevent it. However, you can lower your risk by avoiding certain triggers and risk factors. Prevention strategies include the following:

• Follow your psoriasis treatment plan

• Never stop your psoriasis medications without talking with your dermatologist

• Wear sunscreen and cover your skin when spending time outdoors

• Use stress-management techniques as needed

• Use alcohol sparingly

• See your dermatologist regularly

Related Conditions

Erythrodermic psoriasis may cause life-threatening complications. The condition affects the body’s ability to regulate temperature and fluid balance. Possible related conditions include:

• Dehydration: EP affects how the skin sweats and leads to electrolyte imbalances.

• Edema: EP may lead to swelling in the feet or hands.

• Hypothermia: A person with EP may experience very low body temperatures.

• Infection: Itchy, open sores increase the risk of serious infection and even sepsis (an extreme physical response to infection or injury, causing a dangerous whole-body immune reaction).

• Heart failure: Electrolyte imbalances affect the heart’s ability to function effectively. 
  

Living With Erythrodermic Psoriasis

There is no cure for psoriasis, and lifelong treatment is essential. Fortunately, EP can be well-controlled with medications, light therapy, and topical treatments.

If you're diagnosed with EP, see your dermatologist regularly, and do not change your treatment plan without consulting your healthcare team. 

When To Call Your Healthcare Provider

Call your healthcare provider if you develop any of the following serious symptoms:

• Peeling sheets of skin

• Fever and chills

• Severe pain or itching

• Dehydration

Frequently Asked Questions

Is erythrodermic psoriasis life-threatening?

Erythrodermic psoriasis can be life-threatening because it affects electrolyte balance and how the body regulates temperature. It may lead to heart failure and sepsis. 

When does psoriasis become an emergency?

Psoriasis becomes an emergency when it leads to life-threatening complications, including high fever, fast heart rate, low body temperature, and shedding large sheets of skin. 

What happens if erythrodermic psoriasis is left untreated?

If left untreated, erythrodermic psoriasis can lead to life-threatening problems. The rash covers at least 75% of the body and affects the body’s ability to sweat. See your healthcare provider or emergency department immediately if you develop symptoms of EP.

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