Background/Aims: Erythroderma, a severe dermatologic emergency affecting >90% body surface area with erythema and scaling, frequently complicates psoriasis through shared IL-17/TNF-α inflammatory pathways that synergize with metabolic syndrome (MetS) comorbidities, amplifying cardiovascular risk and therapeutic resistance. Thus, the aim of this study was to assess the frequency of metabolic syndrome in erythroderma patients and correlate it with disease severity among 73 patients using systemic examinations, laboratory investigations, imaging studies, and histopathological evaluation.

Methods & Results: We found that metabolic syndrome prevailed in 68.5% (50/73) of patients, showing a female predominance (68.50 vs. 62.5% in males), with significant correlations to psoriatic histopathology (parakeratosis 12.32%, Munro's microabscesses 5.47%), systemic complications (lymphadenopathy 27.3%, LVH/RVH 24.6%), and mucosal involvement (genital mucosa 50%). Cyclosporine (13.69%) and biologics (infliximab 12.32%) were primary therapies.

Conclusion: Integrated dermatometabolic screening combined with steroid-sparing biologics is essential for optimal severity management in MetS-complicated erythroderma.