PMC3481919_01
Generalized pustular eruption coalescing into lakes at several places
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F1
He had nonfollicular pustules over his entire body that coalesced into lakes at several places [Figure 1]. Plaque lesions of psoriasis were evident over the elbow prominences and abdomen [Figure 1].
Conjunctival and genital mucosal involvement
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F2
Erosions were noted over the palpebral conjunctiva and glans penis [Figure 2].
Orthokeratosis, acanthosis with spongiosis and a superificial dermal lymphocytic infiltrate (H and E, x40)
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F3
Skin biopsy revealed orthokeratosis, mild acanthosis with spongiosis and a superificial dermal lymphocytic infiltrate [Figure 3].
Reappearance of pustules encircling erstwhile plaques of psoriasis
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F4
However, pustules reappeared on the seventh day, encircling the erstwhile plaque lesions of psoriasis [Figure 4].
Second biopsy showing parakeratosis, acanthosis, spongiform neutrophilic abscesses, papillomatosis and a patchy lympho-mononuclear infiltrate in the superficial dermis (H and E, x10, x100)
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F5
A second skin biopsy revealed parakeratosis, acanthosis, spongiform neutrophilic abscesses, papillomatosis and a patchy lympho-mononuclear infiltrate in the superficial dermis, confirming pustular psoriasis [Figure 5].
Clearance of pustular lesions after adding etanercept to ongoing methotrexate, acitretin and NBUVB
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F6
The patient turned afebrile after two doses of etanercept, with complete clearance of the pustular eruption after 1 week [Figure 6].