Generalized Pustular Psoriasis

      A 6-year-old boy presented to our department with a 1-week history of generalized pustules with a high fever. It was suspected that he had pustular psoriasis when he was 8 months old. He had been treated with a topical dry distillation tar of delipidated soybean. The lesions were recurrent but had been under recent control. He had no recent history of infection or any new medication. Physical examination revealed multiple coalescing creamy-white pustules on a background of erythema over the whole body ( Figure 1). Bacterial and fungal cultures of the pus were negative. Histologically, the erythematous pustules on the abdomen showed marked aggregates of neutrophils between degenerated keratinocytes in the uppermost portion of the spinous layer (spongiform pustule of Kogoj, Figure 2; available at www.jpeds.com). Based on these findings, the diagnosis of generalized pustular psoriasis was made. Topical corticosteroids and systemic cyclosporine (5 mg/kg/day) resolved the lesions and fever within 4 weeks.
      Figure 1
      Figure 1 Multiple, coalescing creamy-white pustules with surrounding erythema.

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