Both systemic steroids and high-potency topical steroids, used as monotherapy for psoriasis, may act as precipitating factors for erythrodermic psoriasis.1,2 We certainly do not advocate the use of high-potency topical steroids under occlusion as the sole treatment for erythrodermic psoriasis but, rather, as an adjunct to other modalities, such as methotrexate, etretinate, psoralens plus UV-A, or UV-B, as we stated in our article.3 In the patient described in our report as poorly compliant, emotional stress may have been the precipitant for erythrodermic psoriasis, a factor previously pointed out by Dr Menter.2 The combination of pulsed high-potency topical corticosteroids followed by a course of antiproliferative therapy has been successful in our hands and deserves further study.
We agree with Drs Yen and Raimer that infection may have precipitated the erythrodermic flares in these two patients. Because of the patients' thermodynamic instability, we chose to treat the psoriasis concurrently
Arbiser JL, Arndt KA. Occlusion of Potent Topical Steroids-Reply. Arch Dermatol. 1995;131(2):227. doi:10.1001/archderm.1995.01690140113025