Treatment of Erythrodermic, Severe, or Unstable Psoriasis

Erythrodermic psoriasis and severe or unstable forms of plaque or pustular psoriasis represent acute, potentially life-threatening presentations that require prompt systemic management beyond standard maintenance therapy.

Clinical Scenario This protocol covers patients with erythrodermic psoriasis, severe or unstable plaque psoriasis, or unstable pustular psoriasis — presentations characterised by rapid progression, widespread cutaneous involvement, or systemic instability that necessitates urgent escalation of treatment.

Treatment Approach (Partial) Management involves a targeted biologic agent, which may be used as monotherapy or in combination with an additional systemic therapy. The complete regimen, clinical criteria, and sequencing are available in the full protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jaad.2019.08.049

Cyclosporine is recommended for short-term crisis management of severe or unstable plaque, erythrodermic, or pustular psoriasis until the patient can be transitioned to a medication appropriate for long-term use.
Infliximab can be recommended as monotherapy or in combination with methotrexate for use in pediatric patients with severe plaque or pustular psoriasis that is unresponsive to other systemic medications, rapidly progressive, unstable, and/or life threatening.
The starting dose of infliximab is an infusion of 5 mg/kg administered on weeks 0, 2, and 6 and then every 8 weeks.

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