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.

Generalized pustular psoriasis – a model disease for specific targeted immunotherapy, systematic review

“…As for drugs, literature suggests that both withdrawal and administration of certain pharmaceutics can trigger the development of GPP. Most evidence for a drug precipitating a GPP flare exists for tapering of systemic glucocorticosteroids in psoriasis patients . Thus, systemic steroids should be used carefully in patients with common psoriasis and GPP.…”

Distinguishing pustular psoriasis and acute generalized exanthematous pustulosis on the basis of plasmacytoid dendritic cells and MxA protein

“…Discriminating these two entities has important clinical implications. One of the main triggers of PS is the use of oral corticosteroid therapy, while AGEP is associated with macrolides and beta‐lactam‐based agents, and viral infections. Other triggers for AGEP include quinolones, sulfonamides, terbinafine, antimalarials, calcium channel blockers, non‐steroidal anti‐inflammatory drugs, spider bites and infections by parvovirus B19, cytomegalovirus, coxsackie B4, and mycoplasma pneumonia .…”

Known history of pustular psoriasis with reactivation from in vitro fertilization therapy

“…Patients with underlying psoriasis vulgaris who are exposed to aggravating factors such as pregnancy, infection and sunburn, or who take medications such as terbinafine, chloroquine, ovulation inhibitors, lithium, β-blockers, and prednisone have higher risk of generalized pustular psoriasis 5, 6…”