Annular pustular psoriasis in a 14-month-old girl: a therapeutic challenge

Abstract

Annular pustular psoriasis (annular PP) is a rare but severe variant of psoriasis, which may even occur in early childhood. At this age, therapeutic options are limited and medication issues can be challenging. We report clinical features, diagnostic findings and treatment of an 11-month-old girl with annular PP. Oral acitretin therapy was initiated at 0.9 mg/kg/d and gradually tapered after complete resolution in the subsequent 10 months without relapse. Acitretin proved to be a highly effective therapeutic option in an infant with annular PP.

Management of pediatric psoriasis with acitretin: A review

“…The dose of acitretin was reduced and tapered at 0.1 mg/kg/day and discontinued after 10 months with no relapse in the following three years. The patient experienced mild side effects like cheilitis, reversible hypercholesterinemia, and elevation of alkaline phosphatase (Haug, Benoit, Wohlleben, & Hamm, 2017).…”

“…The patient experienced mild side effects like cheilitis, reversible hypercholesterinemia, and elevation of alkaline phosphatase(Haug, Benoit, Wohlleben, & Hamm, 2017). The dose of acitretin was reduced and tapered at 0.1 mg/kg/day and discontinued after 10 months with no relapse in the following three years.…”

Clinicopathologic retrospective analysis of annular pustular psoriasis

“…It is different from GPP because it has a more subacute and limited clinical course (6,7). In the literature, APP most often occurs in children, and the cases described involve siblings and twins (3,(8)(9)(10)(11)(12). The chance of spontaneous remission is higher in children than in adults.…”

“…The chance of spontaneous remission is higher in children than in adults. Triggering factors are stress, infections, and withdrawal of systemic corticosteroids (3,9,11).…”

“…The clinical picture is characterized by erythematous lesions that are usually polycyclic, with the presence of small, sterile pustules on the circumference of the lesions and fine peeling. Eruptions extend circumferentially and disappear within a few weeks, sometimes leaving little hyperpigmentation (6,9,13). The lesions have a concentric arrangement: paler skin in the center or slight erythema, surrounded by a ring-shaped rash and by numerous pustules.…”