Erythrodermic psoriasis

Acitretine ch3o x x Oral 0.25-1.0 mg/kg/d Psoriasis (erythrodermic, pustular, and severe recalcitrant) Palmoplantar keratoderma pustulosis palmoplantaris, icthyosis, Darier s disease, pityriasis rubra pilaris, lichen ruber planus... 

Erythrodermic psoriasis is a generalized, life-threatening condition that presents with erythema, desquamation, and edema, and may require life support measures as well as systemic therapy. 

Acitretin is most useful for the treatment of severe psoriasis, particularly the pustular and erythrodermic variants. Psoriatic nail changes and arthritis also may respond. Combining the drug with ultraviolet light therapy (Re-UVB, in the case of ultraviolet B radiation, or Re-PUVA, with psoralen plus ultraviolet A radiation) permits the use of lower doses of both acitretin and ultraviolet radiation. Other conditions for which the drug may be especially useful include congenital and acquired hyperkeratotic disorders, such as the ichthyoses and palmoplantar keratodermas, and severe lichen planus. 

Erythrodermic psoriasis results in a widespread erythema that affects most of the body. It is often associated with pustular psoriasis. Oedema, particularly around the ankles, is common, as is excessive exfoliation of the skin and severe itching and/or pain. 

Mr GM is most likely suffering from plaque psoriasis. There is evidence to suggest that he may also have suffered from erythrodermic psoriasis. 

Mr GM s psoriasis has worsened. It was initially characterised by extensive reddening of the skin (which was possibly erythrodermic psoriasis) but it has progressed to a plaque psoriasis. It has failed to respond effectively to treatment so, while it is unlikely that other types of psoriasis will develop, the plaque psoriasis has, and continues to, spread across his body. However, given the drug therapies and issues of Mr GM s compliance, it is possible that initial plaque psoriasis has deteriorated into more unstable forms of the disease, such as erythrodermic psoriasis. 

Topical corticosteroids are usually given in combination with other topical treatments for the treatment of chronic plaque psoriasis. Sensitive areas, such as the face, should be treated with a mild corticosteroid and other areas, such as the scalp, with moderate to potent corticosteroids. In general, use should be maintained as early improvements in the condition are not maintained if use is halted. Such a pattern of use may worsen the condition, possibly causing a deterioration of the condition to unstable forms, such as erythrodermic or pustular psoriasis. Co-administration of topical medicaments usually involves alternating administration of each product. Scalp psoriasis is normally treated with softening emollients in combination with salicylic acid with coal tar or sulphur. 

Acitretin, an oral retinoid, is the active metabolite of etretinate and has demonstrated clinical effects similar to etretinate, but with fewer adverse effects. Acitretin is indicated for the treatment of severe psoriasis, including erythrodermic and generalized pustular types, but is more useful as an adjunct in the treatment of plaque psoriasis. In contrast to the fast-acting cyclosporine and methotrexate, acitretin resolves psoriatic lesions more slowly. 

Psoriasis occurs in several other forms. A form particularly difficult to treat is palmo-plantar psoriasis (PPP), which manifests as pus-fllled spots (pusmles) on the hands and feet. Pustular and erythrodermic psoriasis are two rare forms of the disease, which present as medical emergencies. Both types cover the entire body, as either pus-fllled spots (pustular) or red patches with skin shedding (erythrodermic). 

The Singing Detective in the Dennis Potter play had particularly severe erythrodermic psoriasis.)... 

Korstanje MJ, Bessems PJMJ, van de Staak WJBM. Combination therapy cyclosporin-etretinate effective in erythrodermic psoriasis. Dermatologica (1989) 179,94. 

The use of etretinate either alone or in combination with presently available therapies for psoriasis has been very effective, especially for the typically treatment-resistant pustular and erythrodermic varieties. Unlike isotretinoin in acne, maintenance therapy with etretinate is necessary for most psoriatic patients. This raises questions about the long-term safety and the potential for teratogenicity of this retinoid. So far, no serious toxicity has been observed in patients who have received etretinate for 6 years. 

Erythrodermic psoriasis, a severe disabling variant of psoriasis, which most commonly evolves from pre-existing chronic plaque-type psoriasis, has been associated with co-trimoxazole [189 ]. 

Esposito M, Saraceno R, Schipani C, Marcantonio DD, Bianchi L, Chimenti S. Trimethoprim-sulfamethoxazole induced erythrodermic psoriasis. J Infect 2008 57 (1) 90-2. 

Skin A localized papular rash or aggravation of psoriasis in an edematous or even pustular form are the two most commonly observed complications of treatment with efalizumab [223 ]. Efalizumab can cause exacerbation of psoriasis, including pustular, erythrodermic, and guttate subtypes [225 ], and rebound can also occur after... 

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