红皮病型银屑病诊疗中国专家共识（2024版）

doi:10.35541/cjd.20230570

中华皮肤科杂志 ›› 2024, Vol. 57 ›› Issue (5): 409-417.doi: 10.35541/cjd.20230570

红皮病型银屑病诊疗中国专家共识（2024版）

中国医师协会皮肤科医师分会中国中西医结合学会皮肤性病学分会

中国医师协会皮肤科医师分会中国中西医结合学会皮肤性病学分会

收稿日期:2023-10-07 修回日期:2024-03-22 发布日期:2024-04-30
通讯作者: 史玉玲；王刚；顾军 E-mail:shiyuling1973@tongji.edu.cn;xjwgang@ fmmu.edu.cn;gujun79@163.com
基金资助:
国家重点研发计划（2023YFC2508106）；上海申康医院发展中心第二轮三年行动计划重大临床研究项目（SHDC2020CR1014B、SHDC2020CR6022）；上海申康医院发展中心促进临床专科能力提升项目（SHDC22022302）；上海市级医院诊疗技术推广及优化管理项目（SHDC12023114）；综合医院中西医协同引导项目（第1期）（ZXXT-202212）

Diagnosis and treatment of erythrodermic psoriasis: a Chinese expert consensus statement （2024）

China Dermatologist Association; Combination of Traditional and Western Medicine Dermatology

China Dermatologist Association; Combination of Traditional and Western Medicine Dermatology

Received:2023-10-07 Revised:2024-03-22 Published:2024-04-30
Contact: Shi Yuling;Wang Gang; Gu Jun E-mail:shiyuling1973@tongji.edu.cn;xjwgang@ fmmu.edu.cn;gujun79@163.com
Supported by:
National Key Research and Development Program of China （2023YFC2508106）; Clinical Research Plan of SHDC （SHDC2020CR1014B, SHDC2020CR6022）; Project of Promoting Clinical Expertise Enhancement of SHDC （SHDC22022302）; Project of Diagnosis and Treatment Technology Promotion and Optimization Management of Shanghai Municipal Hospital （SHDC12023114）; General Hospital Chinese and Western Medicine Cooperative Guidance Project （PhaseⅠ）（ZXXT-202212）

摘要/Abstract

摘要： 【摘要】红皮病型银屑病是银屑病的一种特殊类型，以全身皮肤弥漫性潮红、浸润肿胀和大量糠状鳞屑为特征，常伴系统性症状，且病情较严重、容易复发。本共识专家组在国内外最新指南及共识的基础上，结合我国的诊疗现状，针对红皮病型银屑病的病因及发病机制、临床表现、辅助检查、诊断、鉴别诊断及治疗等方面进行了详细阐述并形成共识，旨在进一步规范红皮病型银屑病的诊疗模式，以期为我国红皮病型银屑病的诊疗提供更为科学、权威的参考依据。

关键词: 银屑病, 红皮病型银屑病, 诊断, 治疗, 专家共识

Abstract: 【Abstract】 Erythrodermic psoriasis is a special type of psoriasis, characterized by diffuse erythema, infiltration, swelling and excessive desquamation throughout the body. It is often accompanied by systemic symptoms, leading to serious disease condition, and it is easy to relapse. Based on the latest Chinese and international guidelines and consensus, and combined with the current status of diagnosis and treatment in China, the expert committee established this consensus that focused on the etiology and pathogenesis, clinical manifestations, auxiliary examination, diagnosis, differential diagnosis and treatment of erythrodermic psoriasis, aiming to further standardize the diagnosis and treatment patterns of erythrodermic psoriasis, and provide a more scientific and authoritative reference for its diagnosis and treatment in China.

Key words: Psoriasis, Erythrodermic psoriasis, Diagnosis, Treatment, Expert consensus

中国医师协会皮肤科医师分会中国中西医结合学会皮肤性病学分会. 红皮病型银屑病诊疗中国专家共识（2024版）[J]. 中华皮肤科杂志, 2024,57(5):409-417. doi:10.35541/cjd.20230570

China Dermatologist Association, Combination of Traditional and Western Medicine Dermatology. Diagnosis and treatment of erythrodermic psoriasis: a Chinese expert consensus statement （2024）[J]. Chinese Journal of Dermatology, 2024, 57(5): 409-417.doi:10.35541/cjd.20230570

参考文献 55

［1］	Lo Y, Tsai TF. Updates on the treatment of erythrodermic psoriasis［J］. Psoriasis （Auckl）, 2021,11:59⁃73. doi: 10.2147/PTT.S288345.
［2］	全国银屑病流行调查组. 全国1984年银屑病流行调查报告［J］. 中华皮肤科杂志, 1986,19（5）:253⁃261.
［3］	Ding X, Wang T, Shen Y, et al. Prevalence of psoriasis in China: a population⁃based study in six cities［J］. Eur J Dermatol, 2012,22（5）:663⁃667. doi: 10.1684/ejd.2012.1802.
［4］	Rosenbach M, Hsu S, Korman NJ, et al. Treatment of erythrodermic psoriasis: from the medical board of the National Psoriasis Foundation［J］. J Am Acad Dermatol, 2010,62（4）:655⁃662. doi: 10.1016/j.jaad.2009.05.048.
［5］	Sigurdsson V, Steegmans PH, van Vloten WA. The incidence of erythroderma: a survey among all dermatologists in The Netherlands［J］. J Am Acad Dermatol, 2001,45（5）:675⁃678. doi: 10.1067/mjd.2001.116224.
［6］	Yan D, Afifi L, Jeon C, et al. A cross⁃sectional study of the distribution of psoriasis subtypes in different ethno⁃racial groups［J］. Dermatol Online J, 2018,24（7）:13030/qt5z21q4k2 ［pii］.
［7］	Hawilo A, Zaraa I, Benmously R, et al. Erythrodermic psoriasis: epidemiological clinical and therapeutic features about 60 cases［J］. Tunis Med, 2011,89（11）:841⁃847.
［8］	Chang SE, Choi JH, Koh JK. Congenital erythrodermic psoriasis［J］. Br J Dermatol, 1999,140（3）:538⁃539. doi: 10.1046/j.1365⁃2133.1999.02725.x.
［9］	Goeckerman WH, O′Leary PA. Erythroderma psoriaticum: a review of twenty⁃two cases［J］. JAMA,1932,99 （25）: 2102⁃2105. doi: 10.1001/jama.1932.02740770032007.
［10］	Boyd AS, Menter A. Erythrodermic psoriasis. Precipitating factors, course, and prognosis in 50 patients［J］. J Am Acad Dermatol, 1989,21（5 Pt 1）:985⁃991.
［11］	Heinecke G, Lebwohl M. Erythroderma.In: Buka B, Uliasz A, Krishnamurthy K. Buka′s Emergencies in Dermatology［M］. New York: Springer, 2013:133⁃145. doi: 10.1007/978⁃1⁃4614⁃5031⁃3_7.
［12］	Carrasquillo OY, Pabón⁃Cartagena G, Falto⁃Aizpurua LA, et al. Treatment of erythrodermic psoriasis with biologics: a systematic review［J］. J Am Acad Dermatol, 2020,83（1）:151⁃158. doi: 10.1016/j.jaad.2020.03.073.
［13］	Ogawa K, Okada Y. The current landscape of psoriasis genetics in 2020［J］. J Dermatol Sci, 2020,99（1）:2⁃8. doi: 10.1016/j.jdermsci.2020.05.008.
［14］	Chen L, Tsai TF. HLA⁃Cw6 and psoriasis［J］. Br J Dermatol, 2018,178（4）:854⁃862. doi: 10.1111/bjd.16083.
［15］	Ikäheimo I, Tiilikainen A, Karvonen J, et al. HLA risk haplotype Cw6,DR7,DQA1*0201 and HLA⁃Cw6 with reference to the clinical picture of psoriasis vulgaris［J］. Arch Dermatol Res, 1996,288（7）:363⁃365. doi: 10.1007/BF02507104.
［16］	Li X, Chen M, Fu X, et al. Mutation analysis of the IL36RN gene in Chinese patients with generalized pustular psoriasis with/without psoriasis vulgaris［J］. J Dermatol Sci, 2014,76（2）:132⁃138. doi: 10.1016/j.jdermsci.2014.08.007.
［17］	Fu F, Sun Y, Zhao Q, et al. Rare CARD14 missense variants associated with palmoplantar pustulosis （PPP） in the Chinese Han population［J］. Eur J Dermatol, 2019,29（1）:99⁃100. doi: 10.1684/ejd.2018.3457.
［18］	Lo Y, Chiu HY, Tsai TF. Clinical features and genetic polymorphism in Chinese patients with erythrodermic psoriasis in a single dermatologic clinic［J］. Mol Diagn Ther, 2020,24（1）:85⁃93. doi: 10.1007/s40291⁃019⁃00441⁃x.
［19］	Signa S, Campione E, Rusmini M, et al. Whole exome sequencing approach to childhood onset familial erythrodermic psoriasis unravels a novel mutation of CARD14 requiring unusual high doses of ustekinumab［J］. Pediatr Rheumatol Online J, 2019,17（1）:38. doi: 10.1186/s12969⁃019⁃0336⁃3.
［20］	Piccirillo F, Stinco G, Patrone P. Erythrodermic psoriasis successfully treated with efalizumab［J］. Eur J Dermatol, 2008,18（3）:357⁃358. doi: 10.1684/ejd.2008.0417.
［21］	Kano Y, Teraki Y, Shiohara T. Dramatic improvement of psoriatic erythroderma after acute hepatitis: analysis of cytokine synthesis capability in peripheral blood T cells［J］. Br J Dermatol, 2006,155（2）:455⁃459. doi: 10.1111/j.1365⁃2133. 2006.07270.x.
［22］	Wang H, Wang S, Li L, et al. Involvement of the cytokine TWEAK in the pathogenesis of psoriasis vulgaris, pustular psoriasis, and erythrodermic psoriasis［J］. Cytokine, 2021,138:155391. doi: 10.1016/j.cyto.2020.155391.
［23］	Ma AR, Liu F, Wang R, et al. Prevalence of metabolic syndrome in Chinese patients with erythrodermic psoriasis: a case⁃control study［J］. Front Endocrinol （Lausanne）, 2021,12:677912. doi: 10.3389/fendo.2021.677912.
［24］	Zheng J, Gao Y, Liu N, et al. Higher prevalence of thyroid dysfunction in patients with erythrodermic psoriasis［J］. J Dermatol, 2020,47（9）:1007⁃1012. doi: 10.1111/1346⁃8138. 15427.
［25］	Zhang L, Xue S, Yu J, et al. IgA nephropathy associated with erythrodermic psoriasis: a case report［J］. Medicine （Baltimore）, 2019,98（19）:e15433. doi: 10.1097/MD.0000000000015433.
［26］	Ye F, Gui X, Wu C, et al. Severity evaluation and prognostic factors in erythrodermic psoriasis［J］. Eur J Dermatol, 2018,28（6）:851⁃853. doi: 10.1684/ejd.2018.3437.
［27］	Tso S, Satchwell F, Moiz H, et al. Erythroderma （exfoliative dermatitis）. Part 1: underlying causes, clinical presentation and pathogenesis［J］. Clin Exp Dermatol, 2021,46（6）:1001⁃1010. doi: 10.1111/ced.14625.
［28］	中华医学会皮肤性病学分会. 阿维A治疗银屑病专家共识（2017版）［J］. 中华皮肤科杂志, 2017,50（6）:397⁃399. doi: 10.3760/cma.j.issn.0412⁃4030.2017.06.002.
［29］	Ling MR. Acitretin: optimal dosing strategies［J］. J Am Acad Dermatol, 1999,41（3 Pt 2）:S13⁃17. doi: 10.1016/s0190⁃9622（99）70360⁃9.
［30］	中华医学会皮肤性病学分会银屑病专业委员会. 中国银屑病诊疗指南（2023版）［J］. 中华皮肤科杂志, 2023,56（7）:573⁃625. doi: 10.35541/cjd.20220839.
［31］	Soleymani T, Vassantachart JM, Wu JJ. Comparison of guidelines for the use of cyclosporine for psoriasis: a critical appraisal and comprehensive review［J］. J Drugs Dermatol, 2016,15（3）:293⁃301.
［32］	Bruzzese V, Pepe J. Efficacy of cyclosporine in the treatment of a case of infliximab⁃induced erythrodermic psoriasis［J］. Int J Immunopathol Pharmacol, 2009,22（1）:235⁃238. doi: 10.1177/039463200902200126.
［33］	Esposito M, Mazzotta A, de Felice C, et al. Treatment of erythrodermic psoriasis with etanercept［J］. Br J Dermatol, 2006,155（1）:156⁃159. doi: 10.1111/j.1365⁃2133.2006.07217.x.
［34］	Viguier M, Pagès C, Aubin F, et al. Efficacy and safety of biologics in erythrodermic psoriasis: a multicentre, retrospective study［J］. Br J Dermatol, 2012,167（2）:417⁃423. doi: 10.1111/j.1365⁃2133.2012.10940.x.
［35］	Damiani G, Pacifico A, Russo F, et al. Use of secukinumab in a cohort of erythrodermic psoriatic patients: a pilot study［J］. J Clin Med, 2019,8（6）:770. doi: 10.3390/jcm8060770.
［36］	Saeki H, Nakagawa H, Ishii T, et al. Efficacy and safety of open⁃label ixekizumab treatment in Japanese patients with moderate⁃to⁃severe plaque psoriasis, erythrodermic psoriasis and generalized pustular psoriasis［J］. J Eur Acad Dermatol Venereol, 2015,29（6）:1148⁃1155. doi: 10.1111/jdv.12773.
［37］	Okubo Y, Mabuchi T, Iwatsuki K, et al. Long⁃term efficacy and safety of ixekizumab in Japanese patients with erythrodermic or generalized pustular psoriasis: subgroup analyses of an open⁃label, phase 3 study （UNCOVER⁃J）［J］. J Eur Acad Dermatol Venereol, 2019,33（2）:325⁃332. doi: 10.1111/jdv.15287.
［38］	Yamasaki K, Nakagawa H, Kubo Y, et al. Efficacy and safety of brodalumab in patients with generalized pustular psoriasis and psoriatic erythroderma: results from a 52⁃week, open⁃label study［J］. Br J Dermatol, 2017,176（3）:741⁃751. doi: 10.1111/bjd. 14702.
［39］	Pescitelli L, Dini V, Gisondi P, et al. Erythrodermic psoriasis treated with ustekinumab: an Italian multicenter retrospective analysis［J］. J Dermatol Sci, 2015,78（2）:149⁃151. doi: 10.1016/j.jdermsci.2015.01.005.
［40］	Buggiani G, D′Erme AM, Krysenka A, et al. Efficacy of ustekinumab in sub⁃erythrodermic psoriasis: when TNF⁃blockers fail［J］. Dermatol Ther, 2012,25（3）:283⁃285. doi: 10.1111/j.1529⁃8019.2012.01465.x.
［41］	Signa S, Campione E, Rusmini M, et al. Whole exome sequencing approach to childhood onset familial erythrodermic psoriasis unravels a novel mutation of CARD14 requiring unusual high doses of ustekinumab［J］. Pediatr Rheumatol Online J, 2019,17（1）:38. doi: 10.1186/s12969⁃019⁃0336⁃3.
［42］	Sano S, Kubo H, Morishima H, et al. Guselkumab, a human interleukin⁃23 monoclonal antibody in Japanese patients with generalized pustular psoriasis and erythrodermic psoriasis: efficacy and safety analyses of a 52⁃week, phase 3, multicenter, open⁃label study［J］. J Dermatol, 2018,45（5）:529⁃539. doi: 10.1111/1346⁃8138.14294.
［43］	Trevisan G, Germi L, Naldi L. Erythrodermic psoriasis improved by Tildrakizumab［J］. Dermatol Reports, 2022,14（4）:9448. doi: 10.4081/dr.2022.9448.
［44］	Yamanaka K, Okubo Y, Yasuda I, et al. Efficacy and safety of risankizumab in Japanese patients with generalized pustular psoriasis or erythrodermic psoriasis: Primary analysis and 180⁃week follow⁃up results from the phase 3, multicenter IMMspire study［J］. J Dermatol, 2023,50（2）:195⁃202. doi: 10.1111/1346⁃8138.16667.
［45］	Gioe OA, Savoie C, Grieshaber EB, et al. Treatment of erythrodermic psoriasis with apremilast［J］. JAAD Case Rep, 2021,11:36⁃37. doi: 10.1016/j.jdcr.2021.03.011.
［46］	Megna M, Ocampo⁃Garza SS, Fabbrocini G, et al. A case of erythrodermic psoriasis successfully treated with apremilast［J］. Dermatol Ther, 2022,35（1）:e15204. doi: 10.1111/dth.15204.
［47］	Imafuku S, Okubo Y, Tada Y, et al. Deucravacitinib, an oral, selective tyrosine kinase 2 inhibitor, in Japanese patients with moderate to severe plaque, erythrodermic, or generalized pustular psoriasis: efficacy and safety results from the open⁃label, phase 3 POETYK PSO⁃4 trial［C］//European Academy of Dermatology and Venereology （EADV） 31st Congress, Milan, 2022.
［48］	Hoy SM. Deucravacitinib: first approval［J］. Drugs, 2022,82（17）:1671⁃1679. doi: 10.1007/s40265⁃022⁃01796⁃y.
［49］	Sator P. Safety and tolerability of adalimumab for the treatment of psoriasis: a review summarizing 15 years of real⁃life experience［J］. Ther Adv Chronic Dis, 2018,9（8）:147⁃158. doi: 10.1177/2040622318772705.
［50］	Kurizky PS, Ferreira Cde C, Nogueira LS, et al. Treatment of psoriasis and psoriatic arthritis during pregnancy and breastfeeding［J］. An Bras Dermatol, 2015,90（3）:367⁃375. doi: 10.1590/abd1806⁃4841.20153113.
［51］	Förger F, Zbinden A, Villiger PM. Certolizumab treatment during late pregnancy in patients with rheumatic diseases: low drug levels in cord blood but possible risk for maternal infections. A case series of 13 patients［J］. Joint Bone Spine, 2016,83（3）:341⁃343. doi: 10.1016/j.jbspin.2015.07.004.
［52］	Eworuke E, Panucci G, Goulding M, et al. Use of tumor necrosis factor⁃alpha inhibitors during pregnancy among women who delivered live born infants［J］. Pharmacoepidemiol Drug Saf, 2019,28（3）:296⁃304. doi: 10.1002/pds.4695.
［53］	Owczarek W, Walecka I, Lesiak A, et al. The use of biological drugs in psoriasis patients prior to pregnancy, during pregnancy and lactation: a review of current clinical guidelines［J］. Postepy Dermatol Alergol, 2020,37（6）:821⁃830. doi: 10.5114/ada.2020. 102089.
［54］	Fujita H, Terui T, Hayama K, et al. Japanese guidelines for the management and treatment of generalized pustular psoriasis: The new pathogenesis and treatment of GPP［J］. J Dermatol, 2018,45（11）:1235⁃1270. doi: 10.1111/1346⁃8138.14523.
［55］	Shao S, Wang G, Maverakis E, et al. Targeted treatment for erythrodermic psoriasis: rationale and recent advances［J］. Drugs, 2020,80（6）:525⁃534. doi: 10.1007/s40265⁃020⁃01283⁃2.

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红皮病型银屑病诊疗中国专家共识（2024版）

Diagnosis and treatment of erythrodermic psoriasis: a Chinese expert consensus statement （2024）

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