How Bad Can Psoriasis Get?

John’s comment: Bad enough that I had severe pain when I walked due to psoriasis on the bottom of my feet, bad enough that I had severe pain when water ran against my fingers that were raw from psoriasis, bad enough that my nails were so brittle and fragile they were easily susceptible to breaking and exposing the nail bed, not to mention the disfiguring effect that I’ve had on my face, ears, nails, arms, legs, hands, feet, and other locations, sometimes with pain, sometimes with bleeding.

There is also the driving itch—more compelling than a nicotine addiction. Psoriasis, in its most severe form, may turn the skin red all over the body (erythrodermic psoriasis) or cause pustules to appear (pustular psoriasis). Erythrodermic psoriasis is named because the redness (erythro-) covers the entire body (dermic). This condition is rare but can be very serious. When psoriasis covers the entire body, in addition to discomfort and irritation, the skin’s protective barrier breaks down.

The skin may lose its ability to keep the body from losing water or protect from infection, and sufferers can become dehydrated or acquire an infection that could spread all over the body. When psoriasis is this severe, an individual may need to be admitted to a hospital for fluid infusion, psoriasis treatment, and careful observation to see if the disease improves. Pustular psoriasis can be equally severe. These types of psoriasis are very rare, with erythrodermic psoriasis appearing in only 1% to 4% of people with psoriasis and serious pustular psoriasis in only 0.5% to 2%. 

Historically, these severe exacerbations were more common before the current range  of treatment options became available. The many immunosuppressive medications have allowed physicians to control psoriasis better and more rapidly, helping to prevent this kind of severe disease. Although it is difficult to predict who will experience a serious flare, those with more severe disease are also at a higher risk of complications.

If a person has been using oral steroids such as prednisone for any reason and stops quickly, a severe form of psoriasis may develop when steroids are stopped. For this reason, those with psoriasis should take oral steroids with caution and should watch the skin carefully when the dose is lowered, tapered, or discontinued. Most people with psoriasis will never have to worry about rare types of psoriasis. However, it is important to be aware of skin changes that may need immediate attention and treatment.

Sue’s comment: Showering was a really difficult experience. My skin burned—like pouring vinegar on an open wound—when the water hit my skin. My scalp and under my breasts were the worst. I would cry. Drying after the shower was just as painful. Sleeping was awful. I would itch all throughout the night. When I would drift off to sleep I would be awakened by pain because I’d moved my leg or my arm. I ached constantly.