From the Guidelines
Yes, psoriasis can occur acutely, as evidenced by the existence of erythrodermic psoriasis, a severe form that can develop rapidly and cover most of the body with redness, pain, and shedding of skin. Psoriasis typically presents as a chronic condition with periods of flares and remissions, but it can also develop suddenly as an acute eruption, often triggered by factors such as stress, systemic infections, and medications 1. Acute psoriasis can manifest in various forms, including guttate psoriasis, erythrodermic psoriasis, and pustular psoriasis, each with distinct characteristics and potential triggers.
Key Characteristics of Acute Psoriasis
- Erythrodermic psoriasis: a severe form that can develop rapidly, covering most of the body with redness, pain, and shedding of skin
- Guttate psoriasis: small, drop-shaped lesions that appear after a streptococcal throat infection, particularly in children and young adults
- Pustular psoriasis: painful pustules and systemic symptoms like fever
Management and Treatment
The management of acute psoriasis depends on the type and severity but may include:
- Topical corticosteroids
- Vitamin D analogs
- Systemic medications like methotrexate or biologics
- Addressing any underlying triggers, such as infections, stress, or certain medications It is essential to note that some forms of acute psoriasis, particularly erythrodermic and generalized pustular psoriasis, can be medical emergencies due to potential complications like fluid and electrolyte imbalances, hypothermia, and secondary infections, as discussed in the guidelines for the management of psoriasis and psoriatic arthritis 1.
From the Research
Psoriasis Occurrence
- Psoriasis is a chronic, inflammatory disease affecting 1-3% of the world's population 2
- The course of plaque psoriasis varies, with spontaneous resolution possible but rarely occurring 2
- Guttate (eruptive) psoriasis has frequently a sudden onset and frequently appears abruptly after a bacterial or viral febrile episode of inflammation of the upper ways 2
Acute Onset of Psoriasis
- Guttate psoriasis can occur acutely, with a sudden onset of lesions after a bacterial or viral infection 2
- Pustular and erythrodermic psoriasis are the most severe clinical variants, with diffuse pustular form recurrent episodes of fever and new outbreaks of pustules 2
- Erythrodermic psoriasis corresponds to the generalized form of the disease, with the entire skin being bright red and covered by superficial scales 2
Treatment of Acute Psoriasis
- Phototherapy, such as ultraviolet light B or psoralen plus ultraviolet light A, can be used to treat psoriasis, including acute forms 3, 4
- Systemic therapies, such as methotrexate, acitretin, and cyclosporine, can also be used to treat moderate and severe psoriasis 3, 4, 5, 6
- Biologics, such as etanercept, can be used in combination with conventional systemic agents or phototherapy to treat psoriasis, including acute forms 5, 6