We read with interest the article by Arbiser et al in the June 1994 issue of the Archives.1 They described two patients with erythrodermic psoriasis in whom rapid improvement was seen after initiation of occlusive therapy with topical class 1 steroids. Because of potential side effects from widespread use of class 1 steroids under occlusion and the expense of such treatment, we have reservations about the use of very potent steroids under occlusion as initial therapy.
In both cases reported, a coexisting infection existed that was not treated with antibiotics until the patient was hospitalized. Reported precipitating factors of erythrodermic psoriasis include preceding or coexisting infections, and an untreated coexisting infection can prevent response to treatment. In our experience, occlusive therapy with a mixture of eucerin and 0.1% triamcinolone cream for 15 to 20 minutes two to three times a day produces clearance of erythrodermic psoriasis in 3 days,
Yen A, Raimer SS. Occlusion of Potent Topical Steroids. Arch Dermatol. 1995;131(2):227. doi:10.1001/archderm.1995.01690140113024