Erythrodermic psoriasis usually occurs in the setting of known worsening or unstable psoriasis but may uncommonly be the first presentation of psoriasis. Oral corticosteroids should be avoided if possible because withdrawal risks worsening of the erythrodermic state or even generalised pustular psoriasis. Pustular psoriasis can occur on any part of the body, but occurs most often on the hands or feet. It generally appears on people who have unstable plaque psoriasis. Psoriasis is a long-lasting autoimmune disease characterized by patches of abnormal skin. There are five main types of psoriasis: plaque, guttate, inverse, pustular, and erythrodermic. It is often the result of an exacerbation of unstable plaque psoriasis, particularly following the abrupt withdrawal of systemic glucocorticoids.
Erythrodermic psoriasis of the few skin-condition emergencies, it is a rare but very serious complication of psoriases. 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. Erythrodermic psoriasis is related to unstable plaque psoriasis, a type characterized by lesions which are not clearly defined. It is then considered to be part of the spectrum of unstable psoriasis. In summary, therefore, it can be used as a short-term option to gain control of unstable psoriasis such as pustular psoriasis or erythroderma before returning to other modes of treatment, or more often, as long-term maintenance treatment.
Secondly, erythroderma may be a manifestation of unstable psoriasis precipitated by infection, tar, drugs, or withdrawal of corticosteroids. Patients with generalised pustular psoriasis frequently need to be admitted to the hospital for management. The most common form, plaque psoriasis, appears as raised, red patches covered with a silvery white buildup of dead skin cells. It may occur in association with von Zumbusch pustular psoriasis. It generally appears on people who have unstable plaque psoriasis. An erythrodermic psoriasis flare-up covers most of the body, making the skin look burned. Erythrodermic psoriasis is sometimes accompanied by a severe form of pustular psoriasis. Erythrodermic psoriasis usually occurs in people who already have chronic plaque psoriasis, particularly if it is unstable.
Plaque. This is the most prevalent form of psoriasis and appears as raised, red patches or lesions covered with a silvery white build-up of dead skin cells, called scale. Primarily seen in adults, pustular psoriasis is characterized by white blisters of noninfectious pus consisting of white blood cells surrounded by red skin. It generally appears on people who have unstable plaque psoriasis. According to the National Psoriasis Foundation, It is the least common type of psoriasis and may occur once or more during a lifetime in 1-2 of those with psoriasis. It generally appears on people who have unstable plaque psoriasis. It may also occur in association with von Zumbusch pustular psoriasis. Other less common psoriasis forms include inverse psoriasis (involving the skin folds), erythrodermic (from chronic plaque psoriasis or acute), pustular and guttate (with ‘dewdrop’ lesions). In a rebound episode the disease becomes unstable and rapidly more severe than before therapy.