Pustular psoriasis in Infant/Neonate
In the von Zumbusch type, there is an acute onset of generalized pustules with associated symptoms of pain, fever, malaise, arthralgias, and diarrhea.
L40.1 – Generalized pustular psoriasis
200973000 – Pustular psoriasis
- Acute generalized exanthematous pustulosis (AGEP) – Clinically indistinguishable from pustular psoriasis. Time of onset and a drug history may help differentiate AGEP from pustular psoriasis. Antibiotics are the likely causative agents in AGEP. Histology can also help differentiate between the two. Also look for high fever, edema of the face, pustular eruption that occurs shortly after drug administration (fewer than 2 days), marked serum leukocytosis with neutrophilia, and associated petechiae, purpura, and vesicles in AGEP.
- Toxic epidermal necrolysis
- Drug reaction with eosinophilia and systemic symptoms (DRESS) – Look for marked eosinophilia, visceral involvement (most commonly hepatitis), less acute onset, facial edema, and atypical lymphocytosis.
- Subcorneal pustular dermatosis (Sneddon-Wilkinson disease) – Associated with IgA paraproteinemia and is very responsive to dapsone. Pustular psoriasis is not responsive to dapsone and does not have an IgA paraproteinemia.
- Keratoderma blennorrhagicum seen in reactive arthritis disease – Look for characteristic associated findings including urethritis, arthritis, and ocular findings.
- Dyshidrotic eczema – Extremely pruritic, restricted to hands and feet, look for deep-seated vesicles that look like tapioca pudding.
- Erythema annulare centrifugum – To be considered when annular-type psoriasis is observed. No associated systemic findings. Individual lesions can last for months.
- Disseminated herpes simplex