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Emergency: requires immediate attention
Erythrodermic psoriasis in Child
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Emergency: requires immediate attention

Erythrodermic psoriasis in Child

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Contributors: Craig N. Burkhart MD, Dean Morrell MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Erythrodermic psoriasis (EP) is an acute life-threatening complication of psoriasis. It is the least common form of psoriasis, but it occurs in all ages, from infancy through adulthood. It can occur suddenly, as the first sign of psoriasis, but more commonly develops as a complication of sun exposure, steroid withdrawal, drugs, or an illness in those with known plaque (common) psoriasis or in those with difficult-to-control psoriasis. Additionally, erythroderma may occur from generalized pustular psoriasis. Dehydration and temperature control problems are significant morbidities necessitating hospitalization for fluid management as well as treatment of disease.

Immunocompromised Patient Considerations:
Human immunodeficiency virus (HIV)-associated psoriasis is often severe and refractory to treatment. This is interesting, because HIV is a disease of T-lymphocyte depletion and psoriasis is a disease of cytokine-mediated T-lymphocyte proliferation. Psoriasis is nonetheless exacerbated by HIV.

Codes

ICD10CM:
L40.8 – Other psoriasis

SNOMEDCT:
200977004 – Erythrodermic psoriasis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Erythrodermic pustular psoriasis:
  • Acute generalized exanthematous pustulosis (AGEP) – Clinically indistinguishable from pustular psoriasis. Time of onset and a drug history may help differentiate AGEP from pustular psoriasis. Antibiotics are the likely causative agents in AGEP. Histology can also help differentiate between the two. Also look for high fever, edema of the face, pustular eruption that occurs shortly after drug administration (fewer than 2 days), marked serum leukocytosis with neutrophilia, and associated petechiae, purpura, and vesicles in AGEP.
  • DIHS – May rarely present with pustules.
  • Subcorneal pustular dermatosis (Sneddon-Wilkinson disease) – Rarely erythrodermic.
  • Disseminated herpes simplex

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 09/23/2019
Last Updated: 09/25/2019
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Emergency: requires immediate attention
Erythrodermic psoriasis in Child
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Erythrodermic psoriasis : Chills, Confluent configuration, Desquamation, Erythroderma, Widespread
Clinical image of Erythrodermic psoriasis
Diffuse erythema and thick scales over the dorsal hand in a patient with erythrodermic psoriasis.
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