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Psoriatic erythroderma can be congenital or secondary to an environmental trigger. [12] [13] [14] Environmental triggers that have been documented include sunburn, skin trauma, psychological stress, systemic illness, alcoholism, drug exposure, chemical exposure (e.g., topical tar, computed tomography contrast material), and the sudden cessation of medication.
Erythroderma is generalized exfoliative dermatitis, which involves 90% or more of the patient's skin. [3] The most common cause of erythroderma is exacerbation of an underlying skin disease, such as Harlequin-type ichthyosis, psoriasis, contact dermatitis, seborrheic dermatitis, lichen planus, pityriasis rubra pilaris or a drug reaction, such as the use of topical steroids. [4]
Psoriatic erythroderma (erythrodermic psoriasis) involves widespread inflammation and exfoliation of the skin over most of the body surface, often involving greater than 90% of the body surface area. [18] It may be accompanied by severe dryness, itching, swelling, and pain. It can develop from any type of psoriasis. [18]
Psoriatic arthritis tends to appear about 10 years after the first signs of psoriasis. [3] For the majority of people, this is between the ages of 30 and 55, but the disease can also affect children. The onset of psoriatic arthritis symptoms before symptoms of skin psoriasis is more common in children than adults. [48]
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The body is divided into four sections (head (H) (10% of a person's skin); arms (A) (20%); trunk (T) (30%); legs (L) (40%)). Each of these areas is scored by itself, and then the four scores are combined into the final PASI. For each section, the percent of area of skin involved, is estimated and then transformed into a grade from 0 to 6:
Epidermolytic hyperkeratosis (bullous congenital ichthyosiform erythroderma, bullous ichthyosiform erythroderma) Erythrokeratodermia with ataxia (Giroux–Barbeau syndrome) Familial benign chronic pemphigus (familial benign pemphigus, Hailey–Hailey disease) Fanconi syndrome (familial pancytopenia, familial panmyelophthisis)
The diagnosis of inverse psoriasis is typically clinical, and a physical examination should check for psoriasis in other parts of the body besides skin folds, such as mucosae. [2] When inverse psoriasis is the sole symptom of the illness, diagnosis might be challenging in certain situations and necessitate skin biopsies.