Psoriasis generalized pustular

Etretinate 0 i COOR Oral 0.25-1.0 mg/kg/d Generalized pustular psoriasis, exfoliative psoriasis, plaque psoriasis ... 

Pustular psoriasis may be localized or generalized and may be an acute emergency requiring systemic therapy. Generalized pustular psoriasis is characterized by disseminated deep-red erythematous areas and pustules, which may merge to become "lakes of pus."... 

Trazodone has caused generalized erythematous maculo-papular eruptions (24), erythema multiforme (although the patient was also taking lithium) (25), and generalized pustular psoriasis in a patient who had had stable plaque psoriasis for 19 years (26). 

Barth JH, Baker H. Generalized pustular psoriasis precipitated by trazodone in the treatment of depression. Br J Dermatol 1986 115(5) 629-30. 

Katz M, Seidenbaum M, Weinrauch L. Penicillin-induced generalized pustular psoriasis. J Am Acad Dermatol 1987 17(5 Pt 2) 918-20. 

Acute generalized pustular psoriasis occurred 1 week after ciclosporin withdrawal in a 32-year-old woman... 

Mahendran R, Grech C. Generalized pustular psoriasis following a short course of cyclosporin (Neoral). Br J Dermatol 1998 139(5) 934. 

Sendagorta E, Allegue F, Rocamora A, Ledo A. Generalized pustular psoriasis precipitated by diclofenac and indomethacin. Dermatologica 1987 175(6) 300-1. 

Acitretin, an oral retinoid, is the active metabolite of etretinate and has demonstrated clinical effects similar to etretinate, but with fewer adverse effects. Acitretin is indicated for the treatment of severe psoriasis, including erythrodermic and generalized pustular types, but is more useful as an adjunct in the treatment of plaque psoriasis. In contrast to the fast-acting cyclosporine and methotrexate, acitretin resolves psoriatic lesions more slowly. 

Skin A 67-year-old woman with rheumatoid arthritis and psoriatic arthritis developed a full-body exfoliating pustular rash with fever, confirmed on biopsy as generalized pustular psoriasis, it responded dramatically to methylprednisolone [56 ]. 

Thakor P, Padmanabhan M, Johnson A, Pararajasingam T, Thakor S, Jorgensen W. Ramipril-induced generalized pustular psoriasis. Am J Ther 2010 17(1) 92-5. 

Gamier et al. [90] reported two cases of paraquat poisoning resulted from skin absorption. One patient died from respiratory failure 26 days after applying paraquat onto his whole body as a treatment for scabies. The other with a previous history of psoriasis developed extensive generalized pustular erythroderma and a moderate, transitory renal and respiratory impairment 13 days after exposure. 

Patients with psoriasis who become exposed to high doses of systemic glucocorticoids (7.5 mg prednisolone equivalents or more per day) for more than 7-10 days may develop generalized pustular psoriasis during tapering of the dosage or complete... 

Generalized pustular psoriasis induced by systemic glucocorticosteroids four cases and recommendations for treatment. Br J Dermatol 2009 161(4) 964-6. 

A report of the treatment of 13 patients with severe plaque-type psoriasis, psoriatic arthritis or generalized pustular psoriasis with azaribine 125 mg/kg/day in 4 daily divided doses for 8 weeks is available (14). Two patients with pustular psoriasis did well, but the other 11 patients, though showing a good response in 7, subsequently relapsed while off therapy. 

Topical corticosteroids are usually given in combination with other topical treatments for the treatment of chronic plaque psoriasis. Sensitive areas, such as the face, should be treated with a mild corticosteroid and other areas, such as the scalp, with moderate to potent corticosteroids. In general, use should be maintained as early improvements in the condition are not maintained if use is halted. Such a pattern of use may worsen the condition, possibly causing a deterioration of the condition to unstable forms, such as erythrodermic or pustular psoriasis. Co-administration of topical medicaments usually involves alternating administration of each product. Scalp psoriasis is normally treated with softening emollients in combination with salicylic acid with coal tar or sulphur. 

The first reports of psoriasis in cancer patients treated with high-dose interferon alfa were followed by a controversial debate (295,296). However, numerous cases have confirmed that interferon alfa can either induce typical psoriasis or worsen pre-existing psoriasis (SED-13,1095) (297), an observation that is compatible with interferon aHa-induced imbalance toward an increased Thl response. This was particularly exemplified by the reversibility of the lesions after withdrawal of treatment and the prompt recurrence of symptoms after interferon aha readministration. Exacerbation of psoriasis usuaUy occurred within the first month, whereas a minimum of 2-3 months of treatment was required in patients without a past history of psoriasis (297). Psoriatic lesions at the sites of injection were suggested to be potential indicators for further generalization of psoriasis. In more severe cases, there was concomitant development of monoarticular or polyarticular joint symptoms (SED-13, 1095) (SEDA-21, 372). Pustular psoriasis with balanitis and erosive monoarthritis, suggesting incomplete Reiter s sjmdrome, was also reported in one patient with HLA-B27 (298). 

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