Psoriatic erythroderma
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Psoriatic erythroderma is one of the most severe and potentially life-threatening forms of psoriasis. It is characterized by generalized skin involvement, typically covering more than 80–90% of the body surface, with intense erythema, scaling, and profound disruptions in epidermal barrier function. Unlike limited forms, psoriatic erythroderma is not solely a dermatological condition but a systemic state that can lead to disturbances in thermoregulation, water-electrolyte balance, and an increased risk of infections. For this reason, it requires prompt diagnosis and treatment in specialized care settings.
Psoriatic erythroderma – causes
Erythrodermic psoriasis most commonly develops in patients with previously diagnosed psoriasis, particularly as a result of destabilization of the disease course. The underlying mechanism is a rapid, generalized activation of the skin's immune system, leading to a massive inflammatory state.
The most common triggering factors include:
- sudden discontinuation or improper modification of systemic treatment,
- use of irritating topical methods on extensive skin surfaces,
- acute systemic infections, - severe physical or psychological stress,
- the action of certain drugs that may affect the course of inflammatory skin diseases.
At the pathophysiological level, there is excessive activation of T lymphocytes and increased production of pro-inflammatory cytokines, leading to accelerated keratinocyte proliferation, epidermal differentiation disorders, and significant damage to the skin's protective barrier.
Erythrodermic Psoriasis - Symptoms
The clinical picture of psoriatic erythroderma is usually acute and includes both skin and systemic symptoms. The dominant symptom is an extensive, intense erythema covering almost the entire skin surface, accompanied by severe scaling.
The most common skin symptoms include:
- Generalized erythema with a bright red coloration,
- Fine or lamellar scaling of the epidermis,
- Sensation of burning, tension, and skin soreness,
- Severe itching,
- Swelling of the skin and subcutaneous tissue.
Systemic symptoms include:
- Thermoregulatory disturbances (feeling cold, fever),
- Dehydration and electrolyte imbalances,
- Accelerated heart rate,
- Weakness, weight loss,
- Enlargement of lymph nodes.
Lack of treatment can lead to serious complications, including generalized infections, circulatory failure, and metabolic disorders.
Erythrodermic psoriasis – treatment
Treatment of psoriatic erythroderma requires a comprehensive and coordinated approach. In the acute phase of the disease, patients often require hospitalization and continuous monitoring of their general condition.
The primary goals of treatment include:
- Stabilization of vital functions,
- Inhibition of generalized inflammation,
- Restoration of the skin barrier,
- Prevention of systemic complications.
General management includes correction of fluid and electrolyte imbalances, temperature control, treatment of any secondary infections, and providing adequate nutritional support. Topical treatment plays a supplementary role and primarily involves intensive emollient care and protection of the skin from additional irritants.
Treatment of psoriatic erythroderma
The basis of therapy is systemic treatment aimed at modulating the immune response and reducing inflammation. The choice of therapeutic strategy depends on the severity of the disease, the dynamics of symptoms, and the overall condition of the patient. The treatment may include:
- Biological drugs – targeted at specific pro-inflammatory cytokines (e.g., TNF-alpha inhibitors, IL-17, IL-23), used in patients with a stable overall condition,
- Systemic retinoids – in selected cases, particularly with coexisting keratinization disorders,
- Other forms of systemic treatment with immunomodulatory effects, administered under strict specialist supervision.
The treatment of psoriatic erythroderma is a long-term process and requires regular clinical and laboratory monitoring. Therapeutic consistency, avoiding sudden treatment changes, and close cooperation between the patient and the medical team are of key importance.
