Pustular Psoriasis

1. CASE
PRESENTATION
DERMA- GROUP 3
APRIL 03 – APRIL 09 2023

2. GROUP MEMBERS
63 CHOCKALINGAM VISHWA
64 DAMNIWALA GATI PARESHKUMAR
65 DAS SAKAMBARI
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3. PATIENT IDENTIFYING DATA
Name: P.M
Age: 9 months
Gender: Female
Address: Manuel Guianga, Davao city.
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4. CHIEF COMPLAINT
Generalized erythematous patches with multiple pustules.
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5. HISTORY OF PRESENT ILLNESS
• Four weeks prior to admission (PTA), mother noted few erythematous patches with
pinpoint pustules over the vertex area of the patients scalp which prompted consult in a
local clinic where co-amoxiclav and cetirizine was prescribed and was given for 1 week.
No Improvement was noted.
• Three weeks PTA, lesions on the scalp increased in number which prompted another of
consult her where condition. she was given cefaclor for another week which still did not
provide improvement.
• Two weeks PTA, lesions started to spread all over the head and neck area. Consult was
done and she was given prednisone and cetirizine. Few days after, the erythematous
patches with pustules spread and became generalized with subsequent desquamation.
• Four days PTA, persistence of symptoms now associated with undocumented fever
prompted consult to a private clinic where patient was referred to a dermatologist and
was advised admission
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6. PHYSICAL EXAMINATION:
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• Generalized, erythematous
coalescing patches with crusting.
• Multiple pustules on top of the
erythematous patches over the
extremities.
• Areas of desquamation.

7. SALIENT FEATURES
• 9 Month old Female
• Few erythematous patches with pinpoint pustules over the vertex area of the
patients scalp were noted.
• Co-amoxiclav and cetirizine was prescribed and was given for 1 week and no
Improvement was noted
• Three weeks PTA, lesions on the scalp increased in number
• Two weeks PTA, lesions started to spread all over the head and neck area.
• Four days PTA, persistence of symptoms now associated with undocumented fever
• PE revealed Generalized, erythematous coalescing patches with crusting. Multiple
pustules on top of the erythematous patches over the extremities. Areas of
desquamation.
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8. 8
DIFFERENTIAL DIAGNOSIS

9. RULE IN:
(+) Generalized erythematous patches
(+) Multiple pustules
(+) Cephalocaudal spread
RULE OUT:
(+) Involvement of palm & soles (not seen in FTN) Usually
seen in the 2nd or 3rd day of life
(-) Multiple pustules surrounding the patches (pustules
seen on top of erythematous patches)
Erythema Toxicum Neonatorum (ETN)
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Description : Broad erythematous flare
surrounded by small follicular papule or
pustule
https://emedicine.medscape.com/article/1110731-overview

10. RULE IN:
(+) Generalized erythematous patches
(+) multiple pustules
(+) begins from head and neck area
(+) Spread to trunk and extremities
(+) area of desquamation
RULE OUT:
(+) involvement of palm and soles (sparing noted in SSSS)
(-) systemic symptoms such as fever
(+) multiple pustules
Staphylococcal Scalded Skin
Syndrome
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Description : Broad erythematous flare
surrounded by small follicular papule or
pustule
Bildagentur | mauritius images | 2-month-old with staphylococcal scalded skin
syndrome (SSSS).Staphylococcal scalded skin syndrome is caused by a
Staphylococcus or ìStaphî infection in which the bacteria secrete toxic
substances that cause the top layer of the epidermis to split from the rest of
the skin. (mauritius-images.com)

11. RULE IN:
(+) Generalized erythematous patches
(+) Cephalocaudal spread
RULE OUT:
Usually seen between the fourth and tenth days of life with the
appearance of bullae
(-) sign of pediculosis capitis (Impetigo on the scalp is a frequent
complication of pediculosis capitis)
(-) Systemic symptoms such as fever
(+) multiple pustules (not seen in impetigo)
Bullous impetigo
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Description: Multiple erosive bullae with
erythematous patches
https://dftbskindeep.com/all-diagnoses/impetigo/

12. FINAL DIAGNOSIS
GENERALIZED PUSTULAR PSORIASIS (VON ZUMBUSCH PSORIASIS)
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13. Generalized
pustular
psoriasis
(GPP)
• Generalized pustular psoriasis (GPP) is a rare,
severe form of pustular psoriasis characterized by
widespread, recurrent episodes of neutrophil-rich
pustule formation in the epidermis, which can be
accompanied by fever and systemic inflammation.
• Typical patients with generalized pustular psoriasis
have plaque psoriasis and often psoriatic arthritis.
The onset is sudden, with formation of lakes of pus
peri ungually, on the palms, and at the edge of
psoriatic plaques.
• Erythema occurs in the flexures before the
generalized eruption appears. This is followed by a
generalized erythema and more pustules. Pruritus
and intense burning are often present. Mucous
membrane lesions are common.
• The lips may be red and scaly, and superficial
ulcerations of the tongue and mouth occur.
Geographic or fissured tongue frequently occurs. The
patient is frequently ill with fever, erythroderma,
hypocalcemia, and cachexia.
20XX 13

14. Generalized
pustular
psoriasis
(GPP)
• A number of cases of acute respiratory distress
syndrome associated with pustular and erythrodermic
psoriasis have been reported. Other systemic
complications include pneumonia, congestive heart
failure, and hepatitis.
• Episodes are often provoked by withdrawal of
systemic corticosteroids. The authors have also
observed generalized pustular psoriasis as the
presenting sign of Cushing disease.
• Other implicated drugs include iodides, coal tar,
terbinafine, minocycline, hydroxychloroquine,
acetazolamide, and salicylates. There is usually a
strong familial history of psoriasis.
• Generalized pustular psoriasis may occur in infants
and children with no implicated drug. It may also
occur as an episodic event punctuating the course of
localized acral pustular psoriasis.
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15. DIAGNOSTIC TEST
• Skin biopsy: A skin biopsy involves taking a small sample of skin tissue for examination under a
microscope. This can help confirm the diagnosis of pustular psoriasis and rule out other conditions
with similar symptoms.
• Blood tests: Blood tests can help detect elevated levels of white blood cells, which can indicate an
infection. They can also help evaluate liver and kidney function, as some medications used to treat
psoriasis can affect these organs.
• Cultures: Cultures may be taken from the pus in the blisters to help identify any bacterial or fungal
infections that may be present.
• X-rays: X-rays may be taken to evaluate the joints for signs of arthritis, which can be associated with
pustular psoriasis.
• Patch testing: Patch testing may be done to identify any possible triggers for the psoriasis, such as
allergens or irritants.
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16. TREATMENT
• Admit patient in Dermatology ward
under Dr. Gulliano
• Complete bed rest advised
• Ensure adequate hydration
• Vital signs every 4 hr
• Medications: Acitretin (Soriatane)
0.5mg/kg/day for first 7 days
• Phototherapy: PUVA 3 times per week
• Supportive therapy: Bland topical
compresses.
• Saline or oatmeal baths
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17. Members and contributions
63 CHOCKALINGAM VISHWA - History, PE, Final diagnosis, and discussion
64 DAMNIWALA GATI PARESHKUMAR – Diagnostics and Treatment
65 DAS SAKAMBARI – Salient features, Differential diagnosis
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18. Reference
• Fitzpatrick’s Dermatology Ninth Edition
• Andrews’ Diseases of the Skin Clinical Dermatology (THIRTEENTH EDITION)
• https://www.medscape.com/
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19. THANK YOU
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