engleski

Management of erythrodermic psoriasis

Erythrodermic psoriasis is a severe disabling form of psoriasis with a reported prevalence among psoriatic patients in different studies ranging from 1.5% to 31%. Erythrodermic psoriasis usually develops gradually or acutely during the course of chronic plaque psoriasis. However, it may be uncommonly the first manifestation of psoriasis, even in children. The mean age at onset is about 50 years. Concomitant arthropathy is common. The skin becomes diffusely red, warm, and profoundly scaling to the point of generalized desquamation. Cutaneous blood flow may increase to more than two-thirds normal and can result in congestive heart failure. Temperature control is erratic. The patient suffers protein loss and electrolyte disturbance. In some cases, patients are at a risk of Staphylococcus aureus septicemia due to the skin barrier damage and use of immunosuppressant drugs. Erythrodermic flare is commonly associated with chills, edema, weight loss, pruritus and fever. Complications include dehydration, heart failure, infection, hypothermia, protein loss and edema. The acute respiratory distress syndrome is a possible severe complication. Cases of lethal outcome have also been reported. Systemic diseases, emotional stress, infection, low blood calcium level, alcoholism, drugs like antimalarials and lithium, abrupt discontinuation of corticosteroid therapy, and excessive use of potent local corticosteroids may be precipitating factors for the development of erythrodermic psoriasis. UV radiation in an early eruptive stage of the disease may trigger erythroderma. On making therapeutic decision for erythrodermic psoriasis, patient age, comorbidity and related medication, clinical symptoms and course of disease, recurrence rate, and response to previous therapy should be taken in consideration. Attention should be paid to aggravating factors such as infection, mental stress and some drugs. As erythrodermic psoriasis is a relatively rare disease, there are no controlled studies on particular therapeutic options. Systemic therapy may include retinoids (acitretin), cyclosporine and methotrexate. Although necessary in some cases, systemic corticosteroids should be avoided due to the possible rebound effect. Recently, biologicals have been used in the treatment of erythrodermic psoriasis. Data on the experience with alefacept, etanercept and infliximab have been reported. Patients should be hospitalized and closely monitored. In local therapy, bland emollients and cooling wet dressings are used. Due attention should be paid to the prevention and treatment of possible complications. Antibiotics, diuretics and nutritional support should be administered as needed. A consistent approach to crisis management is essential for patients with erythrodermic psoriasis.

Erythrodermic psoriasis; Cutaneous blood flow; atrophy; therapy

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