Erythodermic Psoriasis in a 67-Year-Old Nigerian Woman – An Unusual Presentation

Abstract

Erythrodermic psoriasis is a rare, severe variant of psoriasis occurring in 1-2% of psoriasis patients. It is often
recalcitrant to conventional treatment and carries a high risk of morbidity and mortality.

We present the case of a 67-year-old Nigerian indigent female who presented with progressive generalized
pruritus, dyspigmentation, extensive desquamation and hyperkeratosis involving 90% of the skin surface area
with nail involvement and joint pains. One morning, the patient noticed the simultaneous loss of skin on both
hands, from the wrist to the fingernails. Overnight, the skin from both her wrists had stripped and hung on her
fingernails in a degloved pattern. Histopathology of skin biopsy supported the diagnosis of erythrodermic
psoriasis. She responded well to systemic corticosteroids, oral methotrexate and locally sourced topical
emollients and keratolytics, which included palm oil and shea butter.

This case describes the clinical presentation of erythrodermic psoriasis and navigates the management of this
dermatosis in a resource-constrained setting, highlighting the efficacy of red palm oil as a topical keratolytic.
Further studies are needed to evaluate its efficacy.