Generalized pustular psoriasis induced by systemic steroid dose reduction

Abstract

Generalized pustular psoriasis, or psoriasis of von Zumbusch, is an acute and severe clinical form of psoriasis, which usually occurs in patients with psoriasis undergoing aggravating factors. In this work, we report the case of a female patient, 70 years old, who developed generalized pustular psoriasis symptoms while reducing the dose of oral corticosteroids, improperly introduced for the treatment of alleged acute generalized exanthematous pustulosis. The differential diagnosis of generalized pustular psoriasis should be made with other pustular dermatoses, such as subcorneal pustulosis, IgA pemphigus and especially with acute generalized exanthematous pustulosis. Personal history of psoriasis and histopathological findings with psoriasiform changes and subcorneal pustule favored the diagnosis. She was treated with acitretin 30 mg / day, progressing to complete regression of the lesions.

Figure 1

Generalized erythema and edema, accompanied by pustular lesions with some crusted areas

Figure 2

Confluence of pustular lesions in the lower limbs, forming lakes of pus

Figure 3

Subcorneal spongiform pustule, acanthosis and exocytosis of neutrophils. In the dermis, mononuclear cells and neutrophils infiltrate (HE, 100x and 400x)

Figure 4

Total regression of lesions, without relapses, 16 months after the introduction of oral retinoid