A Clinical Case of Generalized Pustular Psoriasis in a Pediatric Patient

Abstract

Objectives: A 15-year-old girl presented to the emergency department with a progressive, painful, non-pruritic, scaly, erythematous rash with plaques, predominantly on her chest. Rash appeared 2 weeks ago and started to progress actively 2 days ago. Yellowish flakes were observed on the scalp and on the ears. On the extremities and inguinal region, individual pustular rash elements were noted. Over time, yellowish pustules developed on the arms. Patient had no other systemic symptoms and co-morbidities. A few weeks prior, had experienced a sore throat. Recently, the patient has been under increased stress due to exams and has been suffering from insomnia. Results:• Complete Blood Count: WBC: increased from 9.9 to 16.2× 10 9 ; Neutrophils increased from 6.8 to 12.4 × 10 9.• CRP: Increased from 5 to 7.2 mg/L.• Skin Punch Biopsy: Hyperparakeratosis, psoriasiform features, intracorneal focal neutrophils, moderate peri-vascular lymphocytic infiltration. No fungal changes observed.• Microbiological Tests: S. aureus in cultures from the nose, ears, and superficial wounds.• ANA Test: Negative.• Mantoux Test: Negative.• Diagnosis: Generalized pustular psoriasis. Discussion: Generalized pustular psoriasis (GPP) is a rare, neutrophilic auto skin disease characterized by sudden episodes of widespread rash and sterile pustules. Most common form of psoriasis in children is guttate (plaque) psoriasis. This case highlights the importance of early recognition and diagnosis of GPP in pediatric patients, as it requires targeted treatment strategies such as systemic retinoids (e.g., acitretin).Also, it emphasizes the unique presentation of GPP in a pediatric patient and underscores the need for multidisciplinary care to optimize diagnosis and treatment outcomes.