CURRENT Essentials of Critical Care.pdf

264 Current Essentials of Critical Care■■■Generalized Pustular PsoriasisEssentials of Diagnosis• Serious, potentially fatal form of psoriasis occurring in patientsover age 40• Acute onset of widespread erythematous areas studded with pustules,with accompanying fever, chills, leukocytosis• Recurrent waves of pustulation and remission occur• Mouth and tongue commonly involved• Precipitating events: topical and systemic corticosteroid therapyor withdrawal, medications (sulfonamides, penicillin, lithium,pyrazolones), infections, pregnancy, hypocalcemia• Complications: bacterial superinfection, arthritis, pericholangitis,circulatory shunting with accompanying hypotension, highoutputheart failure, and renal failureDifferential Diagnosis• Miliaria rubra• Secondary syphilis• Pustular drug eruption• FolliculitisTreatment• Retinoids, acitretin, and isotretinoin drugs of choice, but shouldbe avoided in persons with hepatitis, lipid abnormalities; mostshow improvement in 5–7 days• Methotrexate, cyclosporine alternatives in select cases• Avoid systemic steroids■ PearlHIV testing should be carried out in all patients with psoriasis, as severepsoriatic exacerbations occur in HIV-infected individuals.ReferenceMengesha YM, Bennett ML: Pustular skin disorders: diagnosis and treatment.Am J Clin Dermatol 2002;3:389. [PMID: 12113648]