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Generalised Pustular Psoriasis — SCE Dermatology MCQ

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ModerateInflammatory DermatosesGeneralised Pustular PsoriasisSCE Dermatology

A 33-year-old man with long-standing plaque psoriasis develops new erythroderma with widespread pustulation following sudden withdrawal of systemic Prednisolone. His temperature is 38.5°C and he feels systemically unwell. What is the most likely diagnosis?

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Correct answer: E — Generalised pustular psoriasis (von Zumbusch)

Generalised pustular psoriasis (GPP) of von Zumbusch type can be precipitated by sudden withdrawal of systemic corticosteroids in patients with psoriasis. It presents with widespread erythema studded with sterile pustules, fever, and systemic upset. It is a medical emergency requiring hospital admission, fluid resuscitation, and prompt systemic treatment. First-line therapies include Acitretin, Ciclosporin, or Infliximab. Spesolimab (anti-IL-36 receptor) is now available for GPP flares. The key distinction from AGEP is the pre-existing psoriasis history and steroid withdrawal trigger.

Reference: BAD 2020 Psoriasis Guidelines; NICE TA999 Spesolimab