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Psoriatic erythroderma is a condition that occurs in the course of psoriasis. The development of ailments is often associated with overly aggressive ultraviolet treatment or abrupt discontinuation of general medications, which is associated with a “rebound effect”. Symptoms of erythrodermic psoriasis are visible all over the patient’s body.
What is psoriatic erythroderma?
Erythrodermic psoriasis is skin psoriasis that is characterized by the presence of red patches all over the body as a result of the aggravation of the chronic disease. This ailment is a general skin inflammation (up to 90%), the formation of which is influenced by, among others, medications or other comorbid ailments. Although erythroderma is not a serious disease, its late diagnosis and implementation of appropriate treatment may cause dangerous complications, for example from the cardiovascular system.
Note: In some patients, erythrodermic psoriasis may indicate the ongoing development of cancer. Therefore, you should always consult a dermatologist or family doctor.
Types of erythrodermic psoriasis
Erythroderma is divided into:
1. primary – concerning originally healthy skin; the causes of this ailment include:
- exposure of the skin to UV radiation;
- exposure of the skin to irritants;
- taking certain medications, e.g. the use of antibiotics, anti-malarial drugs or sedatives.
2.secondary – related to the presence of other dermatological ailments, e.g.
- psoriasis,
- red dandruff,
- AD (atopic dermatitis),
- lichen planus,
- cutaneous lymphoma,
- skin yeast infection,
- deciduous pemphigus.
The causes of psoriatic erythroderma
Often, the development of erythroderma is associated with too aggressive ultraviolet treatment, less often with the irritating effect of topical drugs. With some general medications, their abrupt discontinuation may be associated with a “rebound effect” and lead to erythrodemia (corticosteroids, efalizumab, rarely cyclosporine), including generalized pustular psoriasis.
DIG. E-16. Psoriatic erythroderma. Erythematous lesions with the presence of peripherally spreading typical psoriatic plaques.
DIG. E-17. Psoriatic erythroderma. Erythematous-exfoliating changes on the lower extremities.
DIG. E-18. Psoriatic erythroderma. Erythematous changes with increased exfoliation on the lower limbs.
Psoriatic erythroderma – symptoms
Psoriatic lesions develop at different rates, sometimes over the course of several days. They may be accompanied by low-grade fever, chills, peripheral lymphadenopathy. It should be emphasized that erythrodermic psoriasis covers a large area of the skin. Exfoliation varies in intensity and may lead to sagging nails. In addition, patients develop itchy skin, swelling, and sometimes even pain. You may feel generally weak and lose a lot of fluid at times. Erythrodemia in generalized pustular psoriasis usually has more severe systemic symptoms (generalized pustular psoriasis).
After some time, the developing erythroderma leads to thickening of the skin layers and complications in the form of:
- heart trouble,
- dehydration,
- anemia,
- hair loss,
- hypothermia
- malnutrition,
- protein deficiency,
- swelling,
- iron deficiency and folic acid,
- circulatory system disorders,
- thrombotic complications,
- liver and kidney disorders,
- gastrointestinal bleeding
- death of the patient.
Psoriatic erythroderma – how to treat?
The choice of treatment depends on the cause of the disease. Most often, doctors recommend topical medications in the form of ointments, sprays or creams (e.g. glucocorticosteroids). In addition, sedatives are used to soothe persistent itching and help the patient fall asleep faster and not scratch the lesions during sleep. In the early stage of the disease, coal tar preparations and light therapy should be avoided as they may worsen the symptoms of erythrodermic psoriasis. Retinoids are also not recommended.
In some cases of psoriasis, topical antibiotics or oral / intravenous antibiotics are prescribed (especially when erythrodermic psoriasis is accompanied by an additional infection). In people whose disease is caused by, for example, cancer – oncological therapy should be implemented.
In summary, the following elements are important in the treatment of erythrodermic psoriasis:
- bed rest,
- hospital treatment (adequate hydration of the patient and regulation of his body temperature),
- applying moist compresses and skin softening preparations to the lesions,
- administering small doses of drugs to the patient,
- treatment of complications.
DIG. E-14. Psoriatic erythroderma. Extensive erythematous-exfoliating changes of the entire skin.
DIG. E-15. Psoriatic erythroderma. Erythematous-exfoliating changes with the presence of erosions and cross-cuts on the forearms.
Psoriatic erythroderma – prognosis and prevention
The prognosis of this ailment depends primarily on its type. Patients who frequently relapse have a worse prognosis and are at risk of death. Unfortunately, the prevention of this disease is practically non-existent. The most important are the early diagnosis and implementation of treatment, and the avoidance of factors that may cause psoriatic erythroderma. It should be remembered that psoriasis will not go away on its own and, if ignored and left untreated, it can ultimately lead to the death of the patient.
Source: A. Kaszuba, Z. Adamski: “Lexicon of dermatology”; XNUMXst edition, Czelej Publishing House