Question

A 56-year-old woman with a history of psoriasis presents with fever, nausea, and painful pin-point pustules on an erythematous base. Her dermatologist recently reduced her prednisone dose. What's the diagnosis?

Answer

Answer: Pustular psoriasis

Pustular psoriasis

Occurs in patients with psoriasis, classically occurring after a decrease in dose or cessation of systemic steroids

Symptoms include:

• Acute eruption of painful small pustules (2-3 mm in diameter) that rapidly become confluent into large “lakes of pus”
• Systemic symptoms may also occur (e.g., fever, malaise, nausea, or arthritis).

These lesions can eventually drain and desquamate, leaving large patches of exposed dermis.

Complications include:

• Super-infection (most common)
• ARDS
• AKI
• Hypothermia secondary to loss of epidermis
• Hypovolemia secondary to fluid losses from the skin

Patients may be admitted for supportive care and treatment with disease-modifying antirheumatic drugs (DMARDs) such as cyclophosphamide or methotrexate.

 

REFERENCE

L Naldi, D Gambini, The clinical spectrum of psoriasis, Clinics in Dermatology, Volume 25, Issue 6, November–December 2007, Pages 510-518

References

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