2. Generalized pustular psoriasis This is one of the most severe form of Psoriasis. The precipitating factors are intermittent infections, hypocalcemia and sudden withdrawal of systemic steroid usage. This condition may occur during pregnancy (impetigo herpetiformis) and may be associated with fetal and maternal mortality. It is characterized by severe constitutional symptoms.
The pustules appear in crops or waves in psoriatic lesions or in normal skin. Complications encountered are dehydration, hypocalcemia, hypoalbuminemia and septicemia. In addition to the general management of the complications, specific treatment includes systemic steroids, methotrexate, oral retinoids or cyclosporin-A.