Diagnosis Of Pustular Psoriasis Research Articles

Young lady with acral pustulosis and psoriatic arthritis

<p>Psoriasis is uncommon in this part of the world, and the pustular variety is even rarer. It is for this reason that the patients are frequently misdiagnosed by their health care providers and presentat late to the dermatologists when complications have already set in. We report a case of a 33 year old female who presented to us with a two year history of pustular eruptions on her hands and feet, pain and swelling of joints in the affected areas and subsequent development of deformities. Prior to her presentation, she has been misdiagnosed as having tuberculosis of the skin as well as leprosy in different hospitals and treated as such with no improvement. On presentation to us, a skin biopsy was done and the specimen sent for histopathology. A diagnosis of pustular psoriasis was made and she was placed on oral methotrexate. She responded to treatment and the lesions resolved in a few weeks except for the joint deformities. This case illustrates the challenges encountered by patients with psoriasis in a resource poor setting like ours as well as the importance of availability of affordable drugs like methotrexate in their management. This is so considering the high cost and non-availability of more modern biologic agents in this part of the world.</p>

Bilateral periocular psoriasis: an initial manifestation of acute generalized pustular psoriasis with coexistent Sjögren's syndrome

A 21-year-old febrile lady presented to the emergency service with severe lid oedema, conjunctivitis, dry mouth and abdominal skin rash. Over 5 days, she developed silvery scales and pustules on the lids, and generalized pustules on an erythematous base. Multiple focal sterile corneal infiltrates were seen. Haematological investigations and a skin biopsy were done as the consulting dermatologist suspected acute generalized pustular psoriasis. In addition, secondary Sjögren's syndrome was diagnosed since she had keratoconjunctivitis sicca, xerostomia, raised erythrocyte sedimentation rate and positive antinuclear antibodies. The presence of microabscesses in the epidermis on skin biopsy confirmed the diagnosis of pustular psoriasis. With oral methotrexate 7.5 mg weekly and topical corticosteroids, the acute condition gradually resolved; however, the keratoconjunctivitis sicca is persisting. Secondary Sjögren's syndrome associated with acute generalized pustular psoriasis and ocular psoriasis is extremely rare. Awareness of the ocular and dermatological features of these two conditions would result in earlier diagnosis and institution of appropriate treatment.

Generalized pustular drug rash induced by hydroxychloroquine.

A 69-year-old man developed a generalized pustular drug rash 2 weeks after starting on hydroxychloroquine sulfate (HCQ) medication. This form of drug eruption had not previously been attributed to HCQ, although a diagnosis of pustular psoriasis cannot be ruled out.

Pustular Psoriasis Elicited By Streptococcal Antigen And Localized To The Sweat Pore

A woman, aged 39 years, presented with a localized, painful, pustular eruption of the neck, scalp, and finger of five years' duration. A diagnosis of pustular psoriasis was made clinically and histologically. It was possible to reproduce the disease by the intradermal injection of killed Group A streptococcal organisms. The induced pustules, as well as those appearing clinically, were intraepidermal and indistinguishable from the Kogoj spongiform abscess, and on serial sectioning showed a distinctive localization to the acryosyringium. Immunosuppressant as well as antistreptococcal therapy in the form of cyclophosphamide and clindamycin was of help. The process is classified as a nonvasculitic pustular bacterid, and as a prototype for antigen localization of lesions to the occluded epidermal sweat duct unit.

Letter: Subcorneal pustular dermatosis vs pustular psoriasis.

To the Editor.— The two cases of subcorneal pustular dermatosis submitted by Johnson and Cripps 1 appear atypical in features other than youthful age alone. The precipitation of eruptions by infection, systemic toxicity with fever, family history of psoriasis (case 2), lesions involving the face and tongue, and lack of response to dapsone but rapid response to systemically administered steroids are atypical for subcorneal pustular dermatosis of Sneddon and Wilkinson 2,3 but characteristic of pustular psoriasis. Additionally, the biopsy features presented by Johnson and Cripps (their Fig 4) reveal a pustule that is distinctly spongiform with pronounced spongiosis and exocytosis of the underlying Malpighian layer. In subcorneal pustular dermatosis, the pustule is superficial, discrete, and nonspongiform with minimal or no spongiosis of the underlying epidermis. 2,3 Johnson and Cripps have considered but rejected the diagnosis of pustular psoriasis in favor of subcorneal pustular dermatosis; I submit that the diagnosis of