Annular pustular psoriasis in a 6-year-old child: Case report

@#Annular pustular psoriasis (APP) is a rare variant of pustular psoriasis occurring only in about 1-5.4% of children with psoriasis. Pustular psoriasis is triggered by endogenous and exogenous factors. Exogenous factors include stress, upper respiratory tract infection and withdrawal of systemic corticosteroids. This condition usually requires systemic treatment. However, there are still no randomized controlled trials or standardized guidelines proving the advantage of any specific treatment modality over the other. We report a case of a 6-year-old male who presented with diarrhea followed by appearance of erythematous annular plaques with pustules and nail changes. Punch biopsy showed pustular psoriasis. Patient was treated with topical betamethasone valerate and calcipotriol, and there was noted to have no recurrence of skin lesions for 4 months.

Generalized Pustular Psoriasis

Generalized Pustular Psoriasis (GPP) is a dermatological emergency that often requires hospitalizationbecause of possible life-threatening complications, including heart failure, renal failure and sepsis. Itis a chronic recalcitrant disease in which acute pustular flares frequently recur on exposure to classictriggers. This review article is aimed to update the new insights into the genetic basis of GPP andhighlighted the central role IL1 and IL36 in the pathogenesis of GPP.

Suspected Case of Iatrogenic Cushing Syndrome Due to Topical Steroid / 대한피부과학회지

Chronic exogenous steroid therapy can result in hypothalamic-pituitary-adrenal axis dysfunction; this usually results from systemic steroid therapy, and is rarely associated with topical steroid therapy. We report a case of suspected iatrogenic Cushing syndrome that developed after the treatment of annular pustular psoriasis. The patient applied clobetasol-17-propionate cream (Betabate(R)) 15~30 g daily, for 4 months, without a dermatologist's prescription. After 4 months of application, the following symptoms developed; a moon face; facial flushing; hypertrichosis; central obesity; purple striae; and multiple erythematous scaly annular patches. The development of Cushing syndrome from exogenous corticosteroid treatment was supported by the typical clinical manifestations and the low basal state of the blood cortisol level, which was perhaps due to secondary suppression of the hypothalamic pituitary-adrenal axis. Steroid-containing drugs, especially during childhood, should be used with caution and monitored carefully.

A Case of Annular Pustular Psoriasis Localized to the Penis / 대한피부과학회지

Annular pustular psoriasis is a rare form of psoriasis characterized by gyrate, annular lesions with an erythematous, scaly, pustular margin. Although usually generalized, in some instances it appears as a localized form. We herein report a case of annular pustular psoriasis localized to the penis of a 55-year-old man. He had a 5-year history of similar lesions on the same area, but there was no evidence of other cutaneous involvement.

A Case of Secondary Syphilis Showing Clinical Features of Annular Pustular Psoriasis Following the Acupuncture and Venous Drainage in a Herb Clinic / 대한피부과학회지

Secondary syphilis has a myriad of clinical presentations as "the great imitator". However, syphilid mimicking annular pustular psoriasis has been rarely reported in the Korean literature. Although the incidence of syphilis has been declining in recent years, serologic testing for syphilis might be mandatory in all types of the unestablished psoriasiform dermatoses, in that failure to diagnose early syphilis correctly can have potentially serious legal ramifications. Though the risk of non-sexual transmission of syphilis has been extremely low, the probability of transmission following needle-stick injury or acupuncture can not be excluded. We herein report a rare case of secondary syphilis with clinical features of annular pustular psoriasis following the repeated acupuncture and venous drainage by a herb doctor.

A Case of Annular Pustular Psoriasis / 대한피부과학회지

Pustular psoriasis refers to a group of disorder characterized by recalcitrant, sterile pustular eruption. It classified into four clinical patterns: Zumbusch, annular, exanthematous, and localized. Annular pustular psoriasis consists of gyrate, annular lesions with an erythematous, scaly, pustular margin. In contrast to the Zumbusch variety, the annular type is benign and less severe. We herein report a case of annular pustular psoriasis of a 9-year-old girl with review of the literature.

A Case of Annular Pustular Psoriasis Showing Features of Subcorneal Pustular Dermatosis / 대한피부과학회지

Annular pustular psoriasis(APP) is a rare variant of the generalized pustular psoriasis characterized by subacute onset of annular lesion with peripheral advancing pustules. Histologically, it is characterized by spongiform and/or subcorneal pustules which are also found in subcorneal pustular dermatosis(SPD). SPD is very difficult to differentiate from APP, although SPD is thought to be a separate and distinctive entity because of its clinical appearance, characteristic histology, and response to dapsone. We herein report a case of APP showing clinical and histologic features of SPD developed in a patient who had a history of generalized pustular psoriasis.