Generalized Pustular Psoriasis Showing Improvement with Corticosteroid Therapy: Case Report

Abstract

Introduction: Generalized pustular psoriasis (GPP) is a rare, acute inflammatory and potentially life-threatening variant of psoriasis, characterized by widespread sterile pustular eruptions on an erythematous base, often accompanied by systemic symptoms such as fever, malaise, and leukocytosis. GPP differs from chronic plaque psoriasis due to dysregulation of the IL-36 pathway and IL36RN mutations, classifying it as an autoinflammatory keratinization disease, which poses significant therapeutic challenges, especially in settings with limited healthcare resources and restricted access to biologic agents.
Case Report: A 43-year-old man presented with high fever, severe skin pain, and widespread pustules coalescing into “lakes of pus.” Histopathological examination revealed orthokeratosis, parakeratosis, regular acanthosis, thinning of the suprapapillary plate, Munro microabscesses, and Kogoj’s spongiform pustules. Case Discussion: A diagnosis of Von Zumbusch-type GPP was established based on clinical and histopathological findings. Although biologic agents are the first- line treatment according to current guidelines, short-term systemic corticosteroids remain an important option in resource-limited settings. The patient responded well to intravenous methylprednisolone and topical corticosteroids, with significant reduction in the Psoriasis Area and Severity Index (PASI) and no relapse during eight weeks of follow-up.
Conclusion: This case underscores the feasibility of achieving remission in generalized pustular psoriasis using conventional systemic corticosteroids under close monitoring, particularly in resource-limited settings where access to biologic agents may be restricted.