Generalized pustular psoriasis.

Abstract

Pustular forms of psoriasis are divided into the localized form (Barber) or the generalized form (von Zumbusch). 1 Most of the recent attention given this subject stresses the differentiation of these entities from impetigo herpetiformis, acrodermatitis continua of Hallopeau, and subcorneal pustular dermatosis of Sneddon and Wilkinson. Stress has been placed primarily on establishing generalized pustular psoriasis as an entity 2-6 or reporting various therapeutic responses. 7,8 The purpose of this paper is to examine 3 cases of acute generalized pustular psoriasis of the von Zumbusch type, paying especial attention to the early changes, systemic and cutaneous, which occur during each exacerbation of the disease. By so doing it is possible to conclude that the earliest pathologic change in the skin appears in the blood vessels. It is also apparent that an initial granulocytosis, which may have arisen as a result of any number of situations, is present. Since the