What Is the Most Severe Form of Psoriasis? Erythrodermic Psoriasis

Symptoms of erythrodermic psoriasis (EP) can be severe. Symptoms may appear quickly at outset or gradually throughout a plaque psoriasis flare.

Signs and symptoms of EP include:

• Red patches on the skin
• Small scaly patches
• Dry, cracked skin
• Itching
• Burning
• Soreness
• 增厚的指甲
• Pitted orridged nails
• Stiff orswollen joints
• Genital sores in males
• Severedandruff
• Increasedheartrate
• Body temperature fluctuations

EP develops progressively in people with plaque psoriasis.Symptoms of psoriasismay worsen and fail to respond to therapy.

Erythrodermic psoriasis (EP) usually affects people who already have psoriasis. Experts are unsure exactly what causes this severe type of psoriasis, but according to the National Psoriasis Foundation, it often appears in people with unstable plaque psoriasis (where psoriasis lesions are not clearly defined).

This condition may be caused by both hereditary and environmental causes. Common causes and risk factors for EP include:

• Pre-existing psoriasis
• Family history
• Alcoholuse
• Vitamin D deficiency
• Stress
• Skin injury
• Dry skin
• Acquired immunodeficiency syndrome
• Autoimmune disorders
• 化疗
• Smoking
• Viral andbacterial infections
• Obesity
• Smoking
• Medications (antimalarials,lithium,trimethoprim/sulfamethoxazole,Bactrim, andSeptra)
• Rebound phenomena following rapid discontinuation of systemic psoriasis therapy, including steroids
• Severesunburn, skin damage, ortrauma, including drug-inducedallergicrash(Koebner phenomenon)
• Male sex
• Age (it occurs at a median age of 53.7 years)

Erythrodermic psoriasis (EP) has no cure, but various treatment options can minimize symptoms. EP treatment typically requires hospitalization. The initial stage is to restore fluid and electrolyte balance and stabilize essential organs such as the heart. The illness can then be treated, generally with a combination of medications.

Treatment options for EP may include:

• Antibiotics to prevent infection
• Biologics
• Systemic medications
• Topical treatments, including wet dressings, oatmeal baths, moisturizers, andcorticosteroidointments
• Combination therapy ofpainmedications, anti-itchointments, andsleep aids

Treating people with EP generally involves the following:

• The first line of therapy is topical steroids to reduce inflammation.
• This is followed by moisturizers, wet dressings, and bed rest to relieve discomfort and itching.
• If this doesn't work, hospitalization may be required, where fluid depletion can be managed with intravenous fluids.
• Therapy often involves the use of topical steroids and systemic immunosuppressivedrugs, as well as regular cardiac and pulmonary monitoring.
• Oatmeal baths and hydration may be recommended.
• Common psoriasis medications include oral环孢霉素or infusions of英夫利昔单抗.

Procedures for the treatment of EP include:

• Ultraviolet B (UVB) phototherapy:Improves mild to moderatepsoriasis symptoms
• Narrow band UVB phototherapy:Improves mild to moderate psoriasis symptoms
• Goeckerman therapy:Improves mild to moderate psoriasis symptoms
• Psoralen plus ultraviolet A therapy:Treats more severe cases of psoriasis
• Excimer laser therapy:Improves mild to moderate psoriasis symptoms

EP may resolve within 3 months if treated properly under expert supervision.

Because the cause is unknown, EP is not necessarily preventable. However, you may be able to reduce your risk of developing the condition by avoiding identified triggers. If you have psoriasis orpsoriatic arthritis, talk to your doctor about your risk factors as well as strategies to protect yourself.

为了防止EP的一集,avoid triggers such as:

• Stress
• Coldweather
• Windy environment
• Excessive alcohol consumption
• Smoking

Otherpreventiontips may include the following:

• Aloe vera:Helps reduce redness, scaling, itching, and inflammation
• Fish oilsupplements:Helps reduce inflammation
• Oregon grape:Helps reduce inflammation

Sometimes, however, the onset of EP is sudden, which makes it very hard to avoid potential triggers.

Following an erythrodermic flare-up, the skin usually returns to its pre-flare state. However, because of the possibility of severe complications, the outlook is mixed:

• EP is associated with fatal outcomes in 4.6%-64% of cases. However, as diagnosis and treatment methods improve, the incidence of deaths is decreasing.
• Pneumonia, septicemia, andheart failureare the most common causes of mortality associated with an erythrodermic flare-up.
• The two EP subtypes have slightly distinct prognoses.
  • People with plaque psoriasis who progress to EP have a better prognosis. Disease progression is largely steady.
  • Prognosis is poor when EP develops quickly in the absence of plaques. Disease progression is fast, unstable, and can cause relapses.

You can expect your skin to return to normal after the flare-up has calmed down. It is critical, however, to contact your dermatologist as soon as you see signs of EP, since EP is considered a medical emergency.