Treatment of Psoriasis in Erythrodermic, Generalized Pustular, or Palmoplantar Disease
Certain psoriasis presentations carry significant clinical severity and require specific systemic management. This protocol is designed for three distinct subtypes — erythrodermic psoriasis, generalized pustular psoriasis, and palmoplantar psoriasis — each of which warrants a tailored therapeutic approach.
Clinical Scenario
This protocol applies to patients with psoriasis presenting as one of the following subtypes:
- Erythrodermic psoriasis — widespread erythema and scaling affecting the majority of the body surface area
- Generalized pustular psoriasis — diffuse sterile pustulation with potential systemic involvement
- Palmoplantar psoriasis — persistent, functionally disabling involvement confined to the palms and soles
Treatment Approach
Oral systemic therapy — including a rapid-acting option particularly suited to acute erythrodermic and pustular flares — forms the basis of management for these subtypes.
Treatment Goals
The primary objective is improvement and clearance of psoriatic skin lesions.
Lesion clearance
References
DOI: 10.1016/j.jaad.2020.02.044
- Cyclosporine can be recommended for the treatment of erythrodermic, generalized pustular, and/or palmoplantar psoriasis.
- Acitretin can be recommended for treatment of erythrodermic, pustular, and palmar-plantar psoriasis.
- The response of pustular psoriasis, both generalized and palmoplantar, to systemic retinoids can be quite rapid and remarkable.
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