There is universal erythema, thickening of the skin, and heavy scaling. This patient had psoriasis as suggested by the large, silvery white scales, and the scalp and nail involvement, which is not seen in this illustration. The patient had fatigue, weakness, malaise, and was shivering. It is quite obvious that such massive scaling can lead to protein loss and the maximal dilatation of skin capillaries to considerable heat dissipation and high-output cardiac failure.