Erythrodermic psoriasis is the least common and most severe variant of psoriasis manifesting as erythema and scaling affecting more than 75% body surface area. Infections, such as COVID-19, are proposed triggers due to provoking immune responses that can progress into a hyperinflammatory state. We present a case of a patient with a history of psoriasis evolving into an erythrodermic form after infection with COVID-19 virus.

A 50-year-old female, clinically diagnosed with plaque type psoriasis for 12 years, sought emergency consult then was admitted due to persistence of generalized erythematous scaly plaques, with accompanying skin and joint pains as well as high grade fever. Definitive diagnosis was done with clinicopathologic correlation including dermoscopy and skin punch biopsy. The patient’s Psoriasis Area and Severity Index (PASI) was 70.2, indicating severe score. SARS-COV-2 RT-PCR was done, revealing a positive result for the causative agent of COVID-19. A multidisciplinary approach to treatment was done with dermatology, rheumatology, and infectious disease services. Medications include antibiotics, antimetabolites, pain medications, and topical steroids. The patient was discharged then would follow-up with the dermatologist with phototherapy and with the rheumatologist. After completing treatment, most lesions have recovered.

Erythrodermic psoriasis is a severe and uncommon form of psoriasis that may be exacerbated by various infections such as COVID-19. Proper history, physical examination, and use of diagnostic procedures can aid in pinpointing the cause of the disease which will be indispensable in managing such patients.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Covid-19 ; Erythroderma ; Dermatitis, Exfoliative ; Psoriasis

Pyoderma gangrenosum causes the destruction of skin tissue and then ulceration. There are currently no international treatment guidelines. Abrocitinib, a JAK1 selective inhibitor, has been used as treatment in some case reports.

A 54-year-old female, diagnosed for 20 years with ulcerative colitis and mostly treated with Chinese herbal medicine, admitted for a solitary painful ulcer on the right lateral ankle, measuring 10x8 cm, with swelling of the right lower leg. Antibiotics were given and wound debridement, exploration, then vacuum-assisted closure dressing were done. She was then referred to dermatology service. Wound care was done by light cleansing of the wound with cold-pressed virgin coconut oil (CP-VCO) - soaked gauze, gentle removal of wound and edge scabs, application of 30% Trichloroacetic Acid on the rounded edges of the ulcer, and covered with a gauze saturated with CP-VCO dressing. Abrocitinib 200 mg/tablet was started once a day. After being discharged, abrocitinib and wound care, with an added pharmacist-compounding of 4% monolaurin, 1% monocaprin, and 10% tranexamic acid in a petrolatum base, was maintained with the same dosage and frequency. At the end of the fourth month, the ulcer completely healed into a solitary pinkish to skin-colored linear scar, measuring at 1.8x4 cm. Dermoscopy monitoring of the wound healing showed progressive lines of epithelialization advancing into the ulcer to a scar with a cribriform pattern of epithelialized red dots.

The excellent results from this pyoderma gangrenosum case report using a combination of these treatment modalities are an opportunity to consider in future clinical cases.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Dermoscopy ; Pyoderma Gangrenosum ; Treatment ; Therapeutics