Erythrodermic psoriasis is usually treated first from the outside in – wet compresses, moisturizers and steroids applied to the skin, and bed rest while in the hospital. Usually, a systemic medication (taken by mouth or injection) such as acitretin, cyclosporine, and methotrexate is started to control the psoriasis quickly. It is important to avoid using oral steroids since they can trigger psoriasis flares. Coal tar preparations and phototherapy (ultraviolet light) should be avoided in the early stages, as they may make it worse, but they can be used after the inflammation has gone down.
Generalized pustular psoriasis is treated with hospitalization, bed rest, fluids (possibly intravenously), and measures to bring the body temperature back to normal. The affected areas of the skin are treated with bland compresses. Systemic drugs including acitretin, cyclosporine, and methotrexate, are often started first. Medications applied to the skin may not be helpful if the symptoms are widespread. If an infection has occurred, antibiotics can be used to treat it.
If it’s suspected that the episode was caused by a medication used to treat psoriasis, the causative medication can be switched to that of another class. Phototherapy (ultraviolet light) may be used once the condition has become less severe.
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