Xu Jia-Ming, Wu Chao, Feng Hao, Jin Hong-Zhong
Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, People's Republic of China.
Psoriasis (Auckl). 2025 Jul 19;15:301-320. doi: 10.2147/PTT.S532062. eCollection 2025.
Erythrodermic psoriasis (EP) is an uncommon and severe form of psoriasis, which exhibits a Th1/Th17/TNF inflammatory pattern. Most patients with EP experience systemic symptoms that necessitate systemic treatments. These treatments include conventional systemic drugs (such as acitretin, cyclosporin A, and methotrexate), biologics (including IL-17, IL-12/23, and TNF-α inhibitors), and small molecule drugs (such as apremilast and JAK inhibitors). Evaluating the severity of EP is critical for determining appropriate treatment strategies. According to an innovative EP severity evaluation approach, patients exhibiting two or more clinical features-fever, exudation, or lymphadenopathy-are classified as having moderate-to-severe EP, while those with one or none of these symptoms are categorized as having mild EP. Mild EP can often be managed with monotherapy using acitretin, methotrexate, or biologics, such as IL-17 or IL-12/23 inhibitors, excluding TNF-α inhibitors. For moderate-to-severe EP, cyclosporine A and biologics, particularly IL-17 or IL-12/23 inhibitors, are recommended. Combination therapies are considered when monotherapies prove ineffective. These may involve combining a biologic with a conventional systemic drug or using two to three conventional systemic drugs together to enhance efficacy. Supportive care plays a critical role in alleviating the discomfort associated with skin lesions and other complications. Additionally, treatments should be tailored to address specific comorbidities, often requiring multidisciplinary collaboration. In our comprehensive review, we summarized the current evidence on therapeutic options for EP, including details on dosages, treatment durations, efficacy, and adverse events. Additionally, we incorporated new evidence on the use of acitretin, biologics, and JAK inhibitors for EP. We also introduced, for the first time, a practical management algorithm based on severity evaluation to guide the appropriate treatment of EP.
红皮病型银屑病（EP）是一种罕见且严重的银屑病形式，呈现Th1/Th17/TNF炎症模式。大多数EP患者会出现全身症状，需要进行全身治疗。这些治疗方法包括传统的全身用药（如阿维A、环孢素A和甲氨蝶呤）、生物制剂（包括IL-17、IL-12/23和TNF-α抑制剂）以及小分子药物（如阿普米司特和JAK抑制剂）。评估EP的严重程度对于确定合适的治疗策略至关重要。根据一种创新的EP严重程度评估方法，出现两种或更多临床特征（发热、渗出或淋巴结病）的患者被归类为中重度EP，而有其中一种或没有这些症状的患者则被归类为轻度EP。轻度EP通常可以使用阿维A、甲氨蝶呤或生物制剂（如IL-17或IL-12/23抑制剂，不包括TNF-α抑制剂）进行单一疗法治疗。对于中重度EP，推荐使用环孢素A和生物制剂，特别是IL-17或IL-12/23抑制剂。当单一疗法证明无效时，考虑联合治疗。这可能包括将一种生物制剂与一种传统的全身用药联合使用，或同时使用两到三种传统的全身用药以提高疗效。支持性护理在减轻与皮肤病变和其他并发症相关的不适方面起着关键作用。此外，治疗应针对特定的合并症进行调整，这通常需要多学科协作。在我们的综合综述中，我们总结了目前关于EP治疗选择的证据，包括剂量、治疗持续时间、疗效和不良事件的详细信息。此外，我们纳入了关于阿维A、生物制剂和JAK抑制剂用于EP的新证据。我们还首次引入了一种基于严重程度评估的实用管理算法，以指导EP的适当治疗。
