Unstable Psoriasis

Unstable psoriasis involves forms of psoriasis that can rapidly progress and cause dangerous or even fatal medical complications. In erythrodermic psoriasis, most of the body may be inflamed and in pustular psoriasis large areas of the body may show small non-infected pustules. This may be a medical emergency and may require admission to hospital.

  • People with stable chronic plaque psoriasis may suddenly progress to unstable psoriasis
  • Simple measures can provide the most benefit for patients
  • Some people have unstable psoriasis as their first presentation of psoriasis
  • It may progress to serious medical complications and even death
  • Triggers include infections, drugs, alcohol and abruptly stopping steroids


In unstable psoriasis, the typical characteristics of psoriasis such as well-defined plaques and silvery scale may be lost.  Erythroderma, or almost total redness of the skin, may be present.  Pustular psoriasis may have sheets of yellow pustules or localised areas of yellow/brown pustules on the body.

Widespread unstable psoriasis may cause itch, pain, burning or tightness due to swelling.

Other features may include swelling of the eyelids (ectropion), thickening of the nails, and swollen lymph glands.

  • Abnormal temperature control of the body
  • Dehydration due to excess fluid loss from the skin
  • Increased heart rate and heart failure or heart attacks
  • Respiratory problems

UNSTABLE PSORIASIS IS A MEDICAL EMERGENCY – present as soon as possible to your closest emergency department, contact your usual dermatologist or present to the Psoriasis Institute. From here, we will co-ordinate admission to a hospital in Brisbane.

The Psoriasis Institute comprises of specialist nurse practitioners and dermatologists who can help diagnose whether you have developed unstable psoriasis.  They may organise initial investigations including biopsies.

Unstable psoriasis usually requires hospital admission.  Our dermatologists at the Psoriasis Institute are also connected with the major hospital dermatology units and can organise an immediate admission if required.

This form of psoriasis is treated in a hospital setting. Our team will co-ordinate admission to a dermatological unit in Brisbane for further management.

  • Fluid/electrolyte monitoring and replacement
  • Bed rest
  • Bland moisturisers and oil baths
  • Steroid creams- moderate strength topical steroids are used with cautious monitoring
  • Systemic treatments (tablets)- medications such as cyclosporine, methotrexate or acitretin may be introduced in some cases of unstable psoriasis.

Unstable psoriasis is the most dangerous form of psoriasis.  While some patients develop it for the first time, others may have repeated deterioration of their usual stable psoriasis.

Patients should be aware of the critical signs of development of this including pustules, rapidly progressive redness and swelling, skin pain, fevers and weakness.

If this happens, immediately see your doctor, as the disease may progress at a dangerous rate.  Hospitalisation, close monitoring and treatment is usually required.

Dr Shobhan Manoharan -  Consultant Dermatologist


  • Narrowband Phototherapy has done wonders for my psoriasis. Only two treatments a week, less than 5 minutes a week and it’s under control. This has helped me decrease my steroid cream application to once a week.
    - Gordon R. St Lucia