Background:
Erythrodermic psoriasis (EP) is a rare but severe condition. Because of its low prevalence, there are no standardized treatment recommendations for EP. Specific EP guidelines are outdated, prioritizing conventional disease-modifying antirheumatic drugs (cDMARDs) and tumor necrosis factor-alpha (TNF-α) inhibitors.

Methods:
We conducted a multicenter retrospective chart analysis in five academic centers in Bavaria, Germany (Augsburg, Erlangen, LMU Munich, TU Munich, Regensburg). Patients diagnosed with EP between 2019 and 2024 who received systemic treatment were included in the study.

Results:
A total of 29 patients were included. cDMARDs were initiated in 8 patients (27.6%). Biologics were used in 21 patients (72.4%). Psoriasis Area and Severity Index (PASI) decreased from 31.9 to 10.8 across all therapies (p < 0.001). PASI 75 was achieved with methotrexate (1), cyclosporine (1), fumarates (1), infliximab (1), ustekinumab (2), ixekizumab (1), secukinumab (2), risankizumab (4), and guselkumab (1). PASI 100 was achieved with infliximab (1), ustekinumab (1), and risankizumab (2). Adverse events occurred most frequently in the cDMARDs group.

Conclusion:
There is a wide variety of treatment approaches. Standardized guidelines are needed. Biologic therapies, especially interleukin (IL)17 and IL23-inhibitors, showed favorable outcomes in this cohort and warrant prospective evaluation.