key: cord-0700048-dlvjitqf
authors: Shahidi Dadras, Mohammad; Diab, Reem; Ahadi, Mahsa; Abdollahimajd, Fahimeh
title: Generalized pustular psoriasis following COVID‐19
date: 2020-12-03
journal: Dermatol Ther
DOI: 10.1111/dth.14595
sha: c972a970300faf01c49678c433afd3cc9a0a4575
doc_id: 700048
cord_uid: dlvjitqf

nan

chain reaction test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive. Oxygen saturation was 98% without an oxygen mask and the patient was discharged with naproxen and hydroxychloroquine. On 18 July 2020, he returned to the hospital with respiratory distress; the computed tomography (CT) scan of the chest revealed bilateral ground-glass opacities ( Figure 1 ). Meropenem, linezolid, vitamin D3, heparin, and intravenous pulse methylprednisolone were added to the treatment protocol. On 27 July, he was discharged on prednisolone 30 mg/day. Two days later, the patient developed fever (39 C) and widespread erythematous patches and pustules ( Figure 1 ). He also complained of bilateral edema of the lower extremities, but color Doppler sonography revealed no signs of deep venous thrombosis. Further questioning indicated that the patient had a history of psoriasis during childhood. A skin biopsy was taken with differential diagnoses of pustular psoriasis and acute generalized exanthematous pustulosis (AGEP); the histopathologic findings were compatible with the former (Figure 1 of the most important drugs used widely as a potential treatment for COVID-19, can induce psoriasis or lead to recurrence or exacerbation of psoriatic lesions. 5 It is proposed that hydroxychloroquine can weaken the outer surface of the skin and lead to abnormal keratinocyte proliferation while interfering with cholesterol metabolism, which is essential for the epidermal barrier integrity; it can hence give rise to psoriasis flares. 5 Although reducing the dose of the systemic corticosteroid in our patient was not rapid, its role should not be overlooked. Important differential diagnoses for pustular psoriasis include AGEP and drug reactions due to the consumption of a new drug like hydroxychloroquine. However, the clinical course and features of these entities are usually similar to a certain limit. 6 Previous history of psoriasis, a long interval between starting the medication and skin eruption and certain pathological features (eg, prominent acanthosis, suprapapillary epidermal thinning, and tortuous papillary dermal capillaries) support the diagnosis of pustular psoriasis. This is while in AGEP, there is no clear history of psoriasis and a shorter interval between drug consumption and skin eruption prevails. Furthermore, the histological findings of AGEP include prominent edema of the papillary dermis, necrotic keratinocytes, and prominent eosinophil infiltration. 6 In this case, the patient had a childhood history of psoriasis. In 

Generalized pustular psoriasis

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