What Should You Know About Erythrodermic Psoriasis?

Written by Stephanie Langmaid, Janie McQueen
Medically Reviewed by Zilpah Sheikh, MD on August 01, 2025
5 min read

Erythrodermic psoriasis (EP) is a rare but very dangerous form of psoriasis. It’s important to know the symptoms. If you think you have erythrodermic psoriasis, see your doctor right away.

The main symptom of EP is fiery red skin from head to toe. Your skin may also be covered in scales and peel off in large pieces. It can be very painful and itchy. You might see tiny blisters called pustules that are filled with pus.

Symptoms can develop over time, but they can also come on suddenly.

You also may have:

 

How does erythrodermic psoriasis affect the skin and body?

EP is a chronic, or ongoing, disease triggered by an overactive immune system. It causes swelling throughout your whole body. You might see lesions on more than 75% of your skin surface. While the discoloration can look a deep red on lighter skin tones, EP can appear brown or purple on darker skin. The symptoms can come and go throughout your life.

“EP is dangerous because it affects the entire skin surface, leading to complications like dehydration, infection, heart failure, hypothermia, and even death,” says Bruce Brod, MD, MHCI, FAAD. He’s a clinical professor of dermatology and director of contact dermatitis and occupational dermatology at the University of Pennsylvania Perelman School of Medicine in Philadelphia.

Your skin is key to your overall health, as it helps control your body temperature, keeps germs and toxins out, and holds moisture in. Erythrodermic psoriasis throws all this off, and the results can be life-threatening. They include a dangerously low body temperature (hypothermia), the loss of much needed proteins and fluids, and severe illnesses such as sepsis and pneumonia. If you lose too much fluid, your heart won’t have enough blood to pump. That may lead to shock, kidney failure, and heart failure.

What are the life-threatening complications of erythrodermic psoriasis?

EP complications that can become life-threatening include:

Psoriasis is an autoimmune disease. It’s when your body’s natural defense system attacks healthy tissue. You’re more likely to get erythrodermic psoriasis if you already have plaque psoriasis, especially if it’s unstable. That means the raised, scaly patches don’t have well-defined edges. But it also affects people who’ve never had the disease.

It can appear if you suddenly stop taking your oral psoriasis medication. Other triggers include:

  • Alcoholism
  • A drug reaction
  • HIV
  • An infection
  • Oral steroid medicines
  • A severe sunburn
  • Stress

Your doctor will start by asking about your health history and doing a physical exam. They’ll ask if:

  • You have a family history of psoriasis.
  • You’ve been exposed to a disease-related trigger such as steroids, an infection, or an abrupt stop of psoriasis meds.

Then, they’ll check you for signs of psoriasis, such as:

They’ll probably do a skin biopsy. The doctor will remove a small piece of your skin and check it in the lab for signs of psoriasis.

What tests are performed to confirm erythrodermic psoriasis?

How your skin looks and biopsy results are likely enough to confirm EP. Your health care provider might order blood tests to rule out other causes of your symptoms and help come up with a treatment plan. For example, lab tests can show if you have anemia, acute fluid and protein loss, abnormal liver function, irregular electrolytes, and more.

If you have symptoms of erythrodermic psoriasis, don’t wait to get help. Go to the hospital right away. Doctors will try to stop the flare-up as quickly as possible and protect you from complications.

Medications. Treatment depends on how bad your symptoms are and whether you have other health problems. You may be prescribed a combination of one or more drugs:

  • Cyclosporine (Sandimmune), infliximab (Remicade), or infliximab-abda (Renflexis) and infliximab-dyyb (Inflectra) may be the first line of defense. They work by stopping the attack of out-of-control immune cells.
  • Your doctor may also prescribe acitretin (Soriatane) or methotrexate to control cell growth.
  • You might take an immune-suppressing drug, such as adalimumab (Humira), adalimumab-atto (Amjevita), brodalumab (Siliq), etanercept (Enbrel), etanercept-szzs (Erelzi), guselkumab (Tremfya), ixekizumab (Taltz), secukinumab (Cosentyx), or ustekinumab (Stelara).
  • These medicines are powerful and can have many side effects. Talk to your doctor to find out if they’re right for you. Make sure they’re aware of any other medical conditions you have or any other medications you take.

Topical treatments. To soothe your skin from the outside, you can use:

  • Steroid cream or ointment moisturizers
  • Wet wraps
  • Oatmeal baths

Other treatments. You may also need:

When is hospitalization necessary for erythrodermic psoriasis?

You’ll need in-hospital care if your EP symptoms, such as abnormal temperature and fluid balance, are more severe than a provider or ER visit can manage. 

“Yes,” says Brod. “Proper management of plaque psoriasis can reduce the risk of EP. Many of the biologics and oral JAK inhibitors used to treat psoriasis can be effective in treating EP.”

You can’t avoid some risk factors, such as a family history of psoriasis. But you can:

  • Let your doctor know if you’re having a reaction to a new medication.
  • Be careful with anything that could irritate your skin.
  • Never abruptly stop taking a psoriasis medication.
  • Cover and treat wounds to prevent infection.
  • Use phototherapy devices carefully to avoid burns.
  • Manage stress.
  • Avoid alcohol.

“Certain triggers such as infections, medication changes, and steroid withdrawal can precipitate EP,” says Brod.

Although erythrodermic psoriasis is estimated to be fatal in 10%-65% of cases, most people do well when taking one or more treatment options. Most EP-related deaths are linked to infection complications such as:

Erythrodermic psoriasis is a severe and dangerous autoimmune disease.

EP engages your whole body, with lesions covering more than 75% of your skin surface area, swelling all over, and erratic body temperature. It requires immediate treatment.

While EP can be fatal, swift medical care during a flare-up and maintaining good skin hygiene will greatly improve your outlook.

What are the early signs of erythrodermic psoriasis?

“Early signs include widespread total skin redness, scaling, itching, and burning sensations,” Brod says. “Fever can also be a component. It may start suddenly or evolve from existing plaque psoriasis.”

How long does erythrodermic psoriasis last?

Erythrodermic psoriasis symptoms tend to come and go. While you can do a lot to control it and minimize your symptoms, flare-ups can still happen. But you can cut down the risk with proper management of plaque psoriasis and staying on top of the meds your caregiver prescribes. 

What happens if you leave psoriasis untreated?

EP can be fatal if you don’t respond quickly and get the right medical care.

Is erythrodermic psoriasis contagious?

No, EP can’t be spread by contact with other people.