Childhood generalized pustular psoriasis treated by preprandial ciclosporin administration: serum cytokine pattern during the course of the disease

Abstract

Conflict of interest: none declared. Generalized pustular psoriasis (GPP) is a rare inflammatory variant of psoriasis, which presents as systemic inflammatory response syndrome (SIRS).1–3 Childhood GPP occasionally develops after streptococcal infection, and an association with acute cytokine response induced by tumour necrotic factor (TNF)‐α has been suggested.4 We used ciclosporin microemulsion preconcentrate with excellent response in a case of GPP. We also analysed the cytokine levels during the disease course. An 8‐year‐old boy developed erythema on his buttock after upper respiratory infection in early December 2007. He was diagnosed by a local dermatologist as having erythema multiforme, and treated with topical steroid ointment, antihistamine administration, dexamethasone 1.5 mg/day and antibiotics for 2 weeks without any beneficial response. He was referred and admitted to our hospital at the end of December. On physical examination, generalized scaly erythema with numerous pustules were found (Fig. 1). The child’s body weight was 38 kg and his temperature was 37.3 °C. There was no personal or family history of psoriasis.