Acute generalized pustular psoriasis, von Zumbusch type, treated in the burn unit. A review of clinical features and new therapeutics.
Generalized pustular psoriasis (GPP) is an immune-mediated dermatologic condition that is characterized by a widespread eruption of sterile, subcorneal pustules. Cases of GPP may present to the burn intensive care unit (ICU), and they may be confused with toxic epidermal necrolysis (TEN) due to the generalized erythema and desquamation. GPP often benefits from admission to an ICU for management of fluid and electrolyte imbalances and for complications such as pneumonitis, renal dysfunction and sepsis. We present the case of a 42 year-old man who was transferred to the burn unit for presumed TEN where he was diagnosed with GPP and successfully treated with intravenous cyclosporine and supportive care. Our objective is to increase awareness of this condition in the critical care community, discuss clinical and laboratory findings, and to review the treatment guidelines published by the National Psoriasis Foundation in August 2012. We also discuss the latest reports utilizing biological response modifying drugs.
Department of Dermatology, University of North Carolina, Chapel Hill, NC, USA.
Katherine M
KM
Varman
Division of Trauma, Surgical Critical Care and Burns/University of Miami Miller School of Medicine, Miami, FL, USA.
Nicholas
N
Namias
Division of Trauma, Surgical Critical Care and Burns/University of Miami Miller School of Medicine, Miami, FL, USA.
Carl I
CI
Schulman
Division of Trauma, Surgical Critical Care and Burns/University of Miami Miller School of Medicine, PO Box 016960 (D-40), Miami 33101, FL, USA. Electronic address: lpizano@med.miami.edu.
Louis R
LR
Pizano
D000208:Acute Disease; D000328:Adult; D002053:Burn Units; D003937:Diagnosis, Differential; D006801:Humans; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D010956:Plasmapheresis; D011565:Psoriasis / Q000175:diagnosis / Q000628:therapy*; D012872:Skin Diseases, Vesiculobullous / Q000175:diagnosis / Q000628:therapy*; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis
D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents
Critical illness; Immune system diseases; Psoriasis