It may occur in association with von Zumbusch pustular psoriasis. TNF-alpha blocking biologics such as Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab) and Simponi (golimumab) target a type of immune cell called a T-cell that specifically cause inflammation in psoriasis and psoriatic arthritis. It can be the result of many inflammatory skin conditions, drugs and malignancies but in a third of cases it is due to psoriasis. Oral corticosteroids should be avoided if possible because withdrawal risks worsening of the erythrodermic state or even generalised pustular psoriasis. It only affects about three percent of people with psoriasis, but can be very serious. This type of pustular psoriasis causes blisters to appear very quickly on the skin.
Erythrodermic psoriasis may develop gradually or occur suddenly and without warning. Extremely itchy skin and severe psoriasis pain are the results. Pustular psoriasis, which is often the underlying type of psoriasis in people who develop erythrodermic psoriasis, is called von Zumbusch pustular psoriasis. It may arise as a result of many inflammatory skin conditions such as eczema, drug eruptions and malignancies. A wide range of cutaneous and systemic diseases can cause erythroderma. The clinical findings in erythroderma caused by reactive arthritis may mimic the appearance of erythrodermic pustular psoriasis.
Erythrodermic psoriasis of the few skin-condition emergencies, it is a rare but very serious complication of psoriases. We will look at the signs and symptoms, complications, and causes of erythrodermic psoriasis. If a patient has a combination of erythrodermic and pustular psoriasis, they may develop excessive fluid build-up, protein loss, and electrolyte imbalances – a serious condition called Zumbusch psoriasis. With this in mind, many psoriasis patients can be on multi-drug regimens; 4 The clinical presentation of drug-provoked psoriasis spans the spectrum of generalized plaque psoriasis, palmoplantar pustulosis, and erythroderma. In psoriasiform eruptions, discontinuation alone can cause rapid regression of the disease. The average age at onset for pustular psoriasis is 50 years. Additionally, erythroderma may result in temperature dysregulation, hypoalbuminemia, and high output cardiac failure.
Erythrodermic Psoriasis Not Just Itchy Skin
Erythrodermic Psoriasis can also cause fluid and protein loss leading to severe illness. Swelling from fluid retention (oedema) may also be found around the ankles and can also develop together with infection. Research indicates that the disease may result from a disorder in the immune system. Sometimes plaque psoriasis can evolve into more inflammatory disease, such as pustular psoriasis or erythrodermic psoriasis. Information on erythrodermic psoriasis a chronic disease of the auto immune system which affects the skin. Guttate psoriasis symptoms can be severe and lead to fatality if left untreated. Erythrodermic psoriasis can sometimes occur alongside von Zumbusch pustular psoriasis. A history of psoriasis may exist, or erythrodermic or pustular disease may be the initial presentation of psoriasis. Patients often appear toxic and present with fever, chills, malaise, and fatigue. Other types are guttate, inverse, erythrodermic, and pustular. Very early results show improvement in plaque psoriasis symptoms for many of these new therapies, but none of them are approved for use yet. A number of conditions may trigger pustular psoriasis, including infection, pregnancy, certain drugs, and metal allergies. Patients with extensive skin involvement may develop exfoliative dermatitis (see Chapter 23 ). Migratory waves of erythema studded with superficial pustules are seen in pustular psoriasis.