Advancing Therapeutic Horizons in Erythrodermic Psoriasis: A Comprehensive Review of Pathophysiology, Biomarkers, and Novel Treatments

Introduction: This review aims to explore and synthesize the current understanding of erythrodermic psoriasis (EP), a rare but severe variant of psoriasis. It focuses on the disease's pathophysiology, associated biomarkers, and both established and emerging therapeutic approaches, with an emphasis on improving patient care and outcomes. Methods: A comprehensive literature review was conducted using databases such as PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. Studies published in English over the last 20 years that addressed the pathophysiology, biomarkers, and treatment of EP were included. A standardized process involving article screening, full-text review, quality assessment, and narrative synthesis was followed to ensure a rigorous and informative analysis. Results: The review highlights that EP is driven by an imbalanced immune response— particularly a shift toward Th2 cytokines—and is associated with biomarkers such as IL- 4, IL-10, and interferons. Traditional therapies like methotrexate, acitretin, and cyclosporine remain essential, while biologics targeting TNF-α and IL-17/IL-23 pathways (e.g., infliximab, secukinumab, guselkumab) have demonstrated promising efficacy, often leading to rapid and sustained clinical improvements. Discussion: The findings emphasize the complexity of EP, especially its immunological underpinnings and clinical unpredictability. Biologics have transformed the treatment landscape, offering hope for more personalized and targeted care. However, gaps remain, particularly in identifying predictive biomarkers and standardizing treatment protocols. The review also acknowledges the need for better monitoring strategies and supportive care, considering the life-threatening potential of EP. Conclusion: Erythrodermic psoriasis requires urgent and individualized management due to its severe clinical nature. While biologics offer substantial therapeutic benefits, continued research into their molecular drivers, biomarker-based monitoring, and innovative therapies is essential. The integration of personalized medicine and AI-supported decision tools could further enhance future management strategies.