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Generalized pustular psoriasis is rare in children, especially in those less than 1 year of age. Lytic lesions of the bone have been reported in children with psoriasis, but are rare. We describe an infant with the clinical and histopathologic features of generalized pustular psoriasis that began in the first few weeks of life. In addition, this patient had sterile lytic lesions of the bone. Despite significant improvement in the bone lesions, his skin condition was resistant to therapy.

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A 12-year-old boy had striking reticulate hyperpigmentation of the neck and upper chest, dystrophic nails, patchy alopecia, and a white streak on the buccal mucosa. He was diagnosed as having chronic graft-versus-host disease (GVHD) based on clinical findings, skin biopsy findings, and his history of a bone marrow transplantation for aplastic anemia eight years earlier. Dyskeratosis congenita (DC) was not a diagnostic consideration, although the clinical findings and history of aplastic anemia made it a compelling possibility. This case highlights the clinical similarities between DC and chronic GVHD and the difficulty in arriving at an unequivocal diagnosis.