Psoriasis affects your body’s immune system, causing it to produce too many skin cells. Those extra cells build up and create a flaky rash that may appear red, purple, ashen gray, or brown, depending on your skin color.

Erythrodermic psoriasis is a very rare type of psoriasis that affects up to just over 2% of people with psoriasis, usually plaque psoriasis.

It causes your skin to lose its ability to regulate your body temperature and protect you against infections. If your body can’t keep itself warm, you could develop hypothermia.

That’s why this condition is considered a medical emergency that needs immediate care, usually in a hospital.

The main symptom of erythrodermic psoriasis is a large rash that covers at least 75% of your body. On lighter skin, the rash appears red. Darker skin may look purple or gray.

Other symptoms include:

  • shedding of the skin in sheets instead of smaller scales
  • skin that looks burned
  • fast heart rate
  • severe pain and itching
  • body temperature that goes up and down, especially on hot and cold days

If you’re experiencing these symptoms, seek immediate medical attention. Erythrodermic psoriasis affects more than just skin. It can also affect the balance of chemicals in your body and lead to body temperature shifts.

Your body might hold onto extra fluid and experience swelling, especially in your ankles. In severe cases, this form of psoriasis can cause pneumonia or heart failure if left untreated.

Doctors don’t know exactly what causes this type of psoriasis.

One theory is that it stems from the immune system reaction that causes your body to overproduce the chemicals that promote inflammation. Genetics may also be involved.

Most people with erythrodermic psoriasis start out with another type of psoriasis, a skin disorder like eczema, or a type of lymphoma that affects the skin.

You might first notice that your skin isn’t getting better with treatment or even that it’s getting worse. Sometimes, a reaction to a medication or abruptly stopping steroids can trigger this condition.

Erythrodermic psoriasis can disrupt your body’s fluid balance and temperature regulation. This could lead to complications like:

  • swelling under the skin, especially in the lower legs and feet, from fluid buildup (edema)
  • dehydration
  • hypothermia
  • infection
  • pneumonia
  • heart failure

A dermatologist may be able to diagnose erythrodermic psoriasis just by examining you.

They may also remove a small piece of your skin and examine it for elevated levels of white blood cells and other substances related to erythrodermic psoriasis.

A blood test may show:

Because erythrodermic psoriasis is a medical emergency, the first step is to call 911 or get to an emergency room. In the hospital, healthcare professionals will restore your body temperature, fluids, and electrolyte balance to their usual levels. You’ll also get medications to treat symptoms.

Stabilizing treatments

You may need to get treatments such as intravenous (IV) fluids and electrolytes in the hospital until you are stable.

You may also receive treatments for any complications. For example, antibiotics treat infections, and diuretics release excess fluid from your body.

Topical treatments

A healthcare professional may apply a steroid cream to your skin, then cover it with a wet gauze dressing to help your skin heal. They may also suggest applying a moisturizing cream to soften your skin and reduce scaling.

Taking a warm bath or oatmeal bath might help you feel more comfortable.

Medication

A few medications that you take by mouth can treat erythrodermic psoriasis, including:

  • biologic drugs, including etanercept (Enbrel) or golimumab (Simponi)
  • cyclosporine, an anti-rejection drug that decreases the immune response that causes psoriasis
  • acitretin (Soriatane)
  • methotrexate

All of these medications can have side effects, and some of them can be serious. It’s important to keep in close touch with your care team while you take them.

Phototherapy

Phototherapy, which uses ultraviolet (UV) light, is another way to help relieve symptoms. The UV light helps reduce inflammation and potentially slows new skin cell growth.

Other treatments

It’s best to see a dermatologist who has experience treating erythrodermic psoriasis.

They may give you a combination of oral and topical medications. Combining a few different medications may work better than taking a single drug alone.

You may also need medications to:

  • relieve pain
  • help you sleep
  • manage the itch
  • clear up a skin infection

Erythrodermic psoriasis triggers can include:

  • severe sunburn
  • infections
  • emotional stress
  • going off steroids too quickly
  • a reaction to medications such as lithium or interleukin II (IL-2)
  • alcohol use

To prevent erythrodermic psoriasis, follow the psoriasis treatment plan your dermatologist or doctor recommends. Try to avoid stress and other known psoriasis triggers.

If your skin starts to get worse, speak with your doctor for a medication adjustment. In severe cases, it may be necessary to call 911 or go to an emergency room for treatment.

Treating erythrodermic psoriasis can involve a lot of trial and error. You may have to try a few different drugs or a combination of medications and lifestyle remedies to find the treatment that works best for you.

You’ll most likely need to keep taking medications over the long term to manage your symptoms. Your doctor can help you find an effective treatment plan to improve your quality of life.

One of the best ways to manage erythrodermic psoriasis is to prevent flare-ups. Avoid potential triggers such as sunburns, infections, and stress whenever possible.