ABSTRACT
Psoriatic erythroderma is one of the most severe forms of psoriasis, which causes significant morbidity and is also potentially life threatening. It occurs in 1%–2.25% of all psoriatic cases. Psoriatic erythroderma can occur due to worsening of psoriasis or sometimes it may be the initial presentation of psoriasis. A detailed history and thorough evaluation of the patient are necessary to establish a diagnosis and rule out conditions that closely mimic erythrodermic psoriasis. Dermoscopy and histopathology of skin are often helpful in diagnosis in a majority of the cases. Management should include careful evaluation for triggering factors and managing them in addition to specific treatments. The majority of erythrodermic psoriasis patients respond to one or more available treatment options; however, a subset of patients does not respond to the treatment and requires a combination of agents. The most common drugs prescribed for erythroderma are methotrexate, cyclosporine, infliximab, and acitretin. There are reports of biologics other than TNF-α blockers, such as IL-17 blockers, being successfully used in the management of erythrodermic psoriasis. The prognostic data for psoriatic erythroderma are deficient and highly variable, with mortality rates ranging anywhere from 9% to 64%. The majority of deaths associated with erythrodermic psoriasis are attributed to bacterial infections, such as pneumonia or staphylococcal septicemia.
