Erythrodermic psoriasis is considered a rare clinical presentation. It may arise from any type of psoriasis and occurs in adults, children and babies . It is well known that trauma, infections and drugs, such as lithium, antimalarials, trimethoprim and sulfamethoxazole, as well as environmental, psychological and metabolic factors can trigger psoriasis and the erythrodermic form of the disease [2, 3].
The generalized manifestations of the disease are erythema, edema, desquamation and systemic compromise (fever, dehydration, malaise and malnutrition) . This disease ranges from mild to severe, as in the case of our patient
Nail malformations, ranging from mild pitting with yellowish discoloration to severe onychodystrophy, are seen in all types of the disease. These symptoms are more pronounced in the fingernails than in the toenails. In addition, several well-designed studies have demonstrated an association between nail lesions and psoriatic arthritis .
The treatment of erythrodermic psoriasis should include rigorous control of a patient's hydration and nutrition. Clinical trials have proven the efficacy of systemic agents such as cyclosporin A or methotrexate, which should be started as soon as a diagnosis is made [6, 7]. Although less used in severe cases, new immunomodulators such as alefacept, efalizumab, etanercept and infliximab, are recommended in mild cases. Their use in severe erythrodermic cases has only been reported incidentally .