Generalized Pustular Psoriasis in an Adolescent Treated with Cyclosporine: A Diagnostic and Therapeutic Challenge

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Roya S. Nazarian
John Nia
Nikki Vyas
Garrett Desman
Lauren Geller


Generalized pustular psoriasis, Dermatopathology, Pediatric dermatology, Psoriasis, Cyclosporine


Generalized pustular psoriasis (GPP) is rare in the pediatric population, accounting for only 0.5-0.6% of psoriasis cases in children. This presents a diagnostic and therapeutic challenge, and often requires a biopsy to differentiate GPP from similar entities such as acute generalized exanthematous pustulosis, though controversy exists regarding the histologic distinction between the two.  We describe a case of GPP in a 15-year-old male presenting with widespread pustular and bullous lesions, fever, and vital instability. The patient was diagnosed with GPP and successfully treated with cyclosporine 3mg/kg/day. He remains in remission on 25 mg acitretin daily.  We present this case to highlight available treatment options for GPP in the pediatric population, and to underscore key clinical and histologic findings to aid dermatologists in proper diagnosis and management of this rare childhood disease.



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