Erythrodermic Psoriasis

Erythrodermic psoriasis is a life-threatening type of psoriasis. Although psoriasis itself is a chronic disease, erythrodermic is one rare and dangerous strain of psoriasis. It is so rare that it constitutes only one to 2.2 percent of the people living with psoriasis. Whereas the total number of people affected by psoriasis in our country can be anywhere between 0.44 to 2 percent of the population. These figures can sum up the rarity of erythrodermic psoriasis.

Erythrodermic-psoriasis

Psoriasis severity, prevalence, spread, and causes depend on the ethnicity, region, genetic, and part of the world the people are living in. That is why although apprehensive research and studies on psoriasis have been going worldwide, our country has to stand with one of its own. 

Talking about erythrodermic psoriasis its epidemiology, its pathophysiology, its pattern of disease, spread, and causes, the triggers, and management of the disease, comorbidities, its effects on quality of life are even more needed areas of research in our country. Now that said about the stand of our country in erythrodermic psoriasis, we shall see about all things we can know about it.

All kinds of psoriasis are chronic, long-lasting, and with no cure. They are here to be permanently in the body. 

Then why alone erythrodermic psoriasis is considered dangerous, fatal, and life-taking? Either way, it is not a vital disorder unlike any. Here is the reason why. 

Erythrodermic psoriasis takes on the skin as the name says dermic in it. It is the redness of the skin. Also called erythema. It can be due to many reasons like medications allergies, infections, reactions to medications, etc but in the worst case due to erythrodermic psoriasis. 

Ideally, erythroderma is a skin condition, which is a complete redness of the skin.it can occur rarely but it can happen after withdrawing the psoriasis medications. 

The erythrodermic psoriasis is a worsening kind of psoriasis with erythema the redness of the skin. 

Edema is the accumulation of fluids in the skin leading to swellings in the ankles and feet, due to fluid retention. 

The disease disrupts the thermoregulation of the skin. Studies and research have shown a drastic loss of much-needed proteins, drainage of fluids from the body in a patient with erythrodermic psoriasis. 

Hypothermia is a condition of low body temperature. One of the signs of this erythrodermic psoriasis is hypothermia. As the patient will be having a red rash of erythroderma from head to toe, the body lets go of the water by evaporation. Also with the loss of balancing fluids, the body falls into hypothermia. 

This after some time, falls into more complicated issues of the heart, and other vital operations in the body. The fall in the temperature can go as low as 23 degrees rectal temperature. A patient suffering from hypothermia or erythrodermic psoriasis will be needing hospitalization for better management of the wound. Also, a monitored replacement of electrolytes and fluids will be done accordingly. 

Erythrodermic psoriasis

Symptoms of Erythrodermic Psoriasis

  • Erythrodermic psoriasis shows all of its symptoms potentially through the skin. Clinical symptoms can be presented as severe scalings on the skin, hair falling off the body,  not well-defined psoriasis plaques, occasionally seen exudative lesions on the skin. 
  • Skin peels off in large pieces with a lot of itch and pain. 
  • Pus-filled pustules as in pustular psoriasis are seen as tiny blisters. 
  • Nails change very commonly in erythrodermic psoriasis. They form pits, thickened nails, even to the extent of changes in the nail plate layers, apart from color changes. 

Other systemic indications in the case of erythrodermic psoriasis are 

  • fevers, 
  • chills, weakness, 
  • fast heartbeat than normally, 
  • unease or difficulty in being regular,
  • Dehydration due to the evaporation,
  • Swelling in the lymph nodes,
  • Pain in the joints,
  • And also pain in the muscles,
  • Diarrhea,
  • Severe sweating,
  • Constipation,
  • Weight fluctuations,
  • And nervous sensitivity, etc.

Diagnosis of Erythrodermic Psoriasis

A key suggestion practiced clinically to determine whether it is erythrodermic psoriasis the patient is suffering from is if it involves at least 75 percent of the body surface. Some look for 90 percent too. However, if  75 percent of the body is covered with erythema showing all other typical signs of erythrodermic psoriasis it is taken for further tests. 

Lab tests generally look for inflammations, triggers causing erythema, fluid and electrolyte loss, temperature irregularities in the body, weight changes, erythrocyte sedimentation rate, etc.

However, physical examination looking for psoriasis traces, scales, and pustules will be done. 

If the suspicion for the disease is high, histological analysis by biopsy. Which will indicate the infiltrate of lymph cells and red blood cells with heavily expanded capillaries etc. 

In addition, a deeper look into the skin diseases and family history of them are taken into consideration.

Medications used, history of taking steroids, and other chronic medications are checked upon. 

erythrodermic-psoriasis

Types of Erythrodermic Psoriasis

Although these are not declared, clinically two types are considered for an easier approach.

the first type is where both psoriasis-affected areas and the erythema-affected areas are demarcated. This type of erythrodermic psoriasis has a stable progression so the approach of treatments can be easier.

The second type of the disease is set on the presence of psoriasis arthritis. It has a rapid spread of erythema over the body with less evident psoriatic plaque. This has no regular progression of the disease, so the prognosis takes cues from vital signs. 

Other lesser-known types of erythrodermic psoriasis are congenital erythrodermic psoriasis and triggered erythrodermic psoriasis. The potential triggers are drugs, topical steroids, alcohol, smoking, chemicals, etc.

Treatments for Erythrodermic Psoriasis

  • Dexamethasone topical ointment has shown skin clearing. Steroids alongside an alternative are given as a treatment. Primarily the correction of the body fluid loss, electrolyte abnormalities is done. Methotrexate, clobetasol, desonide, etc are given topically.
  • Vitamin D analogs, phototherapy, second-generation retinoids are the next lines used.
  • Cyclosporine, mycophenolate mofetil, biologic therapies, infliximab, golimumab, ustekinumab, etc are utilized in treating erythrodermic psoriasis.

Reference:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761022/
  2. https://pubmed.ncbi.nlm.nih.gov/29200239/
  3. https://pubmed.ncbi.nlm.nih.gov/4233865/
  4. https://www.sciencedirect.com/topics/medicine-and-dentistry/erythrodermic-psoriasis
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5572467/
  6. https://pubmed.ncbi.nlm.nih.gov/19842576/