DOI: https://doi.org/10.36347/sasjm.2026.v12i03.007

Pages: 192-195

Background: Psoriasis is a chronic immune-mediated inflammatory disease that typically follows a controllable course under dermatological management. However, severe phenotypes may evolve into life-threatening systemic conditions requiring intensive care unit (ICU) admission. Despite this risk, psoriasis remains under-recognized as a cause of critical illness, and guidance on ICU management is limited. Objectives: To illustrate the spectrum of critical complications associated with severe psoriasis, identify clinical warning signs necessitating ICU admission, and highlight key principles of intensive care management through representative clinical cases. Methods: We report three severe and illustrative cases of psoriasis complicated by life-threatening systemic manifestations : methotrexate toxicity in end-stage renal disease, erythrodermic psoriasis, and generalized pustular psoriasis complicated by drug reaction with eosinophilia and systemic symptoms (DRESS). Clinical presentation, laboratory findings, therapeutic interventions, and outcomes are analyzed in the context of current literature. Results: All cases demonstrated rapid progression from cutaneous disease to systemic inflammatory failure. Two patients developed multiorgan dysfunction and died despite intensive care management. One patient with erythrodermic psoriasis recovered following aggressive ICU stabilization and subsequent biologic therapy. These cases underscore the role of systemic inflammation, immunosuppression, infection, and drug toxicity in driving critical illness among patients with psoriasis. Conclusions: Severe psoriasis should be regarded as a multisystem inflammatory disorder with the potential for critical deterioration. Early recognition, strict pharmacovigilance, prompt ICU referral, and close collaboration between dermatologists and intensivists are essential to improving outcomes. Integrated care pathways bridging dermatology and intensive care medicine are urgently needed for hig