Chronic annular pustular psoriasis resembling subcorneal pustular dermatosis: A case report

Abstract

Generalized pustular psoriasis and subcorneal pustular dermatosis are generalized pustular dermatoses that are characterized by the subcorneal accumulation of neutrophils. Careful examination is important in distinguishing these diseases for appropriate management. Patients with acute generalized pustular psoriasis are systemically unwell with discrete pustules as opposed to the chronicity and associated hypopyon lesions in subcorneal pustular dermatosis. Generalized pustular psoriasis lesions demonstrate psoriasiform changes on histology and the increased expression of Th17 cytokines. We describe a middle-aged woman presenting with chronic annular generalized pustular psoriasis, initially mistaken for subcorneal pustular dermatosis due to their clinical and histological semblance. The patient had recurrent skin disease for 6 years despite conventional therapy of oral retinoid, immunosuppressant and biologic therapy. Complete and persistent clearance of her skin lesions was achieved with secukinumab, an interleukin 17A inhibitor.

Generalized Pustular Psoriasis in a 4 Year-old

“…However, the hallmark features of GPP include classic psoriasiform changes seen in the epidermis, such as parakeratosis and elongation of rete ridges. 7 In GPP, neutrophils that migrate from dilated vessels in the papillary dermis into epidermis aggregate beneath the stratum corneum to form the 'spongiform pustules of Kogoj' . 8 The histopathological result in our case suited the characteristic of GPP.…”

Subcorneal pustular dermatosis as a cause of pityriasis amiantacea in a young child

“…GPP, on the other hand, reveals the classic psoriasiform changes, parakeratosis, elongation of rete ridges, spongiform pustules of Kogoj, and acantholysis. 4 The treatment of choice in children is dapsone, similar to what is indicated for adults. However, cases of hematologic toxicity from the drug have been reported in children, mainly hemolytic anemia and methemoglobinemia.…”

Treatment of recalcitrant subcorneal pustular dermatosis with guselkumab

“…Histopathologically, the most commonly described feature of both SPD and generalized pustular psoriasis (GPP) is neutrophil accumulation within the epidermis. In addition, annular GPP is often similar to SPD in form 3 . Therefore, it is suggested that some cases of SPD may represent a variant of GPP.…”