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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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