Treatment of Erythrodermic Psoriasis: Practical Application of the National Psoriasis Foundation Consensus Statement

Abstract

The management of erythrodermic psoriasis often presents a dermatologic challenge because of the lack of adequate high-quality medical literature concerning treatment options, side effect profiles associated with available therapies, and the development of concomitant comorbidities during treatment that further limit therapeutic options. After reviewing the literature published on erythrodermic psoriasis, taking into account the quality of the evidence-based medicine, in April 2010 the medical board at the National Psoriasis Foundation released a consensus algorithm for treating the patient with erythrodermic psoriasis. We present a case of a 53-year-old man with a 20-year history of plaque psoriasis who developed an erythrodermic exacerbation involving 100% body surface area. The patient was eventually administered cyclosporine 5 mg/kg/day divided into two equal doses, and the results of this treatment were excellent. He was eventually changed to a maintenance regimen involving cyclosporine 3.5 mg/kg/day divided into two equal doses along with methotrexate 15 mg weekly given for a 1-month period followed by a 1-month drug holiday. The patient has been successfully maintained on this intermittent regimen for the past 3 years with no evidence of toxicity.