Psoriasis: When It's an Emergency

Psoriasis is irritating, stressful, even debilitating, but it is seldom thought of as life-threatening. However, there are rare cases where a flare-up can be a medical emergency. Two very rare types of psoriasis, erythrodermic psoriasis and generalized pustular psoriasis, can cause fever, fluid loss and other dangerous problems.

Erythrodermic psoriasis
Erythrodermic psoriasis tends to produce large, red patches, often covering nearly all of the skin surface. It may be accompanied by severe itching and pain. It can occur suddenly as the first sign that a person has psoriasis or occur more gradually and affect people who already have plaque psoriasis. It can be brought on by:

• an infection, including HIV
• stress
• alcohol consumption
• suddenly stopping systemic psoriasis medications (taken by mouth or injected)
• strong irritants like coal tar preparations
• some medications, including TNF-alpha inhibitors, trimethoprim-sulfamethoxazole, bupropion and pegylated interferon-alpha with ribavarin

Erythrodermic psoriasis is dangerous because it can disrupt your body's ability to control its temperature and can lead to dehydration and heart failure. If you’re experiencing signs of erythrodermic psoriasis, you should go to an emergency room immediately.

Generalized pustular psoriasis
If you develop generalized pustular psoriasis, also known as von Zumbusch psoriasis, you'll certainly want to see a doctor – you won't need to be told to do so. It comes on quickly (in as little as a few hours) and produces the following symptoms:

• widespread areas of red skin
• pain and tenderness
• white blisters filled with non-infectious pus that will dry and peel within a day or two, leaving the skin smooth and shiny – they may start as small blisters and then join together to form larger blisters

You may also experience the following:

• fever
• chills
• severe itching
• rapid heartbeat
• thirst and dehydration
• muscle weakness
• loss of appetite
• nausea
• leg swelling

Generalized pustular psoriasis may occur in people who have a history of plaque psoriasis, but it may also affect people who have not previously had psoriasis. Many times, there is no identifiable cause for the flare-up, but some possible triggers include:

• infection
• suddenly stopping systemic psoriasis medications (taken by mouth or injected)
• pregnancy
• some medications, such as amoxicillin, terbinafine, codeine, ceftriaxone, oxacillin and rituximab
• topical medications (medications that are applied to the skin) that have strong irritating effects, including some psoriasis treatments

Generalized pustular psoriasis can severely affect the heart and lungs, especially if the person is elderly. It can also affect the liver and kidney and disturb the body's fluid balance. Anyone experiencing it should go to an emergency room immediately.

Fortunately, both of these forms of psoriasis are very rare.

All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Psoriasis-When-Its-an-Emergency

Erythrodermic psoriasis is usually treated first from the outside in – wet compresses, moisturizers and steroids applied to the skin, and bed rest while in the hospital. Usually, a systemic medication (taken by mouth or injection) such as acitretin, cyclosporine, and methotrexate is started to control the psoriasis quickly. It is important to avoid using oral steroids since they can trigger psoriasis flares. Coal tar preparations and phototherapy (ultraviolet light) should be avoided in the early stages, as they may make it worse, but they can be used after the inflammation has gone down.

Generalized pustular psoriasis is treated with hospitalization, bed rest, fluids (possibly intravenously), and measures to bring the body temperature back to normal. The affected areas of the skin are treated with bland compresses. Systemic drugs including acitretin, cyclosporine, and methotrexate, are often started first. Medications applied to the skin may not be helpful if the symptoms are widespread. If an infection has occurred, antibiotics can be used to treat it.

If it’s suspected that the episode was caused by a medication used to treat psoriasis, the causative medication can be switched to that of another class. Phototherapy (ultraviolet light) may be used once the condition has become less severe.

All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Psoriasis-When-Its-an-Emergency

If a mild or medium-strength steroid preparation is applied to the skin, there usually isn't too much concern about side effects. They may cause some irritation or acne or a burning sensation, but the symptoms of the psoriasis itself will likely be much worse. There is also the possibility of thinning of the skin or loss of skin colour, so let the doctor know if you see any changes to the skin.

If a medication is also taken by mouth, it will most likely be acitretin, methotrexate, or cyclosporine. Your overall physical health will affect whether you can take them; if you have problems with your liver or kidneys, for example, you may not be able to take these medications, or you may need more frequent check-ups while you are on them. Make sure that the doctors who are treating you know about all other physical conditions that you have.

If you're a woman, it is also important to let the doctor know if you're pregnant, if you may be pregnant or if you're planning to become pregnant in the next 3 years. Both acitretin and methotrexate can cause birth defects. Methotrexate can also cause birth defects if the father of the child has been taking it at or up to 3 months before the time of conception. Women should wait at least 3 years after taking acitretin before getting pregnant, and 6 months after the last dose of methotrexate. Men taking methotrexate should wait 3 months after their last dose of medication before fathering a child.

All three medications have the possibility of making you feel a bit worse at first – for example, increased itching or soreness. These effects will often go away after a little while. If you experience symptoms such as extreme dizziness, intense stomach pain, difficulty breathing, blood in your urine or other similar changes to your health, make sure to let your doctor know right away. For more information on these medications, see our medication database.

If you are given phototherapy, it will involve two or three treatments per week until the psoriasis clears. This is sometimes called photochemotherapy, which involves using phototherapy with a medication called psoralens that increases your skin’s sensitivity to light. The aim of the therapy is to produce inflammation and redness in the skin, which might sound undesirable, but it slows down the production of new skin cells, which is the problem. Before receiving phototherapy, let your doctor know of any conditions you may have that increase your sensitivity to sunlight. Also let the doctor know about all medications you are taking, as some medications can increase sensitivity. As well, if you are a woman and are or may be pregnant, you should not take psoralens.

All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Psoriasis-When-Its-an-Emergency

Generalized pustular psoriasis will affect older people more severely than younger people; for seniors, it is very important to get treatment immediately. It occasionally affects children, but when it does, it tends to be less acute. Complications that may follow include infections, kidney and liver problems, breathing difficulties and even death. Once the condition is treated, however, the blisters will subside within several days although the scaling and redness may take longer. However, there is also the possibility of erythrodermic psoriasis developing, and there is a real possibility of a recurrence of the generalized pustular psoriasis. Thus, if you have had an attack of generalized pustular psoriasis, you should be more watchful than usual for signs of another attack and continue any treatments recommended by your doctor.

Erythrodermic psoriasis carries a risk of some complications, including dehydration, heart failure, infection, hypothermia, malnutrition, and swelling. The treatment of erythrodermic psoriasis is intended as much to prevent and treat these complications as it is to treat the psoriasis itself. This is why it is important to get treatment as soon as possible. Keeping track of any possible triggers can help to prevent future relapses from occurring.

All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Psoriasis-When-Its-an-Emergency