ABSTRACT
Erythrodermic and generalized pustular psoriasis can become dermatologic emergencies. This chapter reviews the clinical presentation, epidemiology, and management of erythrodermic and generalized pustular psoriasis. It considers inpatient admission for patients that are systemically ill with fevers, chills, shortness of breath, or changes in mental status. Erythrodermic psoriasis presents as an intense, bright-red, inflammatory dermatitis involving at least 75% of the body surface area. Pustular psoriasis has been historically classified into two forms: localized and generalized. The most effective and rapid control of erythrodermic or generalized pustular psoriasis is achieved with high-dose of cyclosporine or through infusions of infliximab. Common side effects from short-term cyclosporine use include gastrointestinal discomfort, temperature hypersensitivity, and electrolyte abnormalities. The rapidity of skin improvement on cyclosporine can easily deceive a clinician into decreasing the dose of cyclosporine prematurely. If the patient is not pregnant, acitretin can be added to cyclosporine as a second medication to further enhance the efficacy and rapidity of the onset of action.
