P12 Bidirectional associations with erythrodermic psoriasis: a cohort study from the British Association of Dermatologists Biologics and Immunomodulators Register

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ID: 318406
2026
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Abstract
Abstract Introduction and aims Erythrodermic psoriasis (EP) is a severe variant of psoriasis affecting over 90% of the skin. Although it is associated with significant morbidity, risk factors and long-term consequences are poorly understood. This study aimed to identify demographic, lifestyle and clinical determinants of EP, and to assess subsequent risk of comorbidities. Methods Data from the British Association of Dermatologists Biologics and Immunomodulators Register were analysed. Participants registered between September 2007 to November 2025 were included. Baseline variables associated with prevalent EP were identified, and further investigated in two cohort analyses. Firstly, risk of incident EP was investigated using Cox regression, excluding those with prevalent EP. Secondly, associations with comorbidities were explored by using prevalent EP as the exposure and incident comorbidities as outcomes. Relationships between continuous variables and EP were modelled using restricted cubic splines to allow for nonlinearity. Potential confounders were included as covariates. Effect estimates are given as adjusted hazard ratios (aHRs). Results Of the 16 206 included participants, 2518 (16%) had prevalent EP. During 106 649 person-years of follow-up, 52 (0.3%) developed EP [incidence rate 0.49, 95% confidence interval (CI) 0.36–0.69]. Incident EP was associated with weekly alcohol consumption (aHR 1.02 per unit, 95% CI 1.00–1.03), palmoplantar pustulosis (aHR 3.79, 95% CI 1.13–12.73) and asthma (aHR 2.85, 95% CI 1.48–5.49), and nonlinearly with baseline Psoriasis Area and Severity Index, age of onset and disease duration (P < 0.05). Prevalent EP was associated with an increased risk of incident nonlocalized pustular psoriasis (aHR 2.08, 95% CI 1.28–3.37) and stroke (aHR 1.69, 95% CI 1.29–2.23), but not asthma (aHR 1.18, 95% CI 0.90–1.54) or palmoplantar pustulosis (aHR 1.71, 95% CI 0.90–3.26). Conclusions Higher alcohol consumption, asthma and palmoplantar pustulosis were associated with an increased risk of incident EP. In turn, EP conferred a greater risk of subsequent pustular psoriasis and stroke. Further studies are needed to confirm these findings and elucidate the underlying mechanisms, which could inform strategies to improve EP management.
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Authors Ali Al-Janabi, Oras Alabas, C. Smith, P Laws, Zenas Yiu, Richard Warren
Journal the british journal of dermatology
Year 2026
DOI
10.1093/bjd/ljag151.053
URL
https://doi.org/10.1093/bjd/ljag151.053
Keywords Keywords not found

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