Pustular Psoriasis

presented by

David Elpern MD

Williamstown, MA, USA

on December 29th, 2000

The patient is a 56 year old woman with a one year history of a progressing lesion on the right leg. Over the past couple of months she has developed similar but less advanced lesions on the right palm and on the arms. The leg lesion began in 12/99 as a plaque R leg and has grown centrifugally. She is in good general health and takes no medications other than "herbs." Lives with husband and they run an inn and restaurant. She has been worked up by a very competent dermatologist with lab, cultures and biopsy - all with non-conclusive findings.


There is a large patch on the right anterior leg which measures ~ 15 cm in diameter. The most significant aspect is the presence of deep-seated pustules. The surface is glazed and there is some crusting, especially around the periphery. She has similar but much less pronounced lesions on the right palm and on the arms.

There is uniform psoriasiform epidermal hyperplasia, parakeratosis, thinning of the suprapapillary plates, spongioform pustules within the epidermis and cornified layer and a superficial mixed inflammatory inflitrate in the papillary dermis. PAS stain negative for fungi. The histologic pattern is consistent with pustular psoriasis.

The patient was started on Methotrexate 12.5 mg per week and halobetasol proprionate 0.05% ointment bid.

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