Treatment of generalized pustular psoriasis with etretinate (Ro 10-9359) and methotrexate

A case of generalized pustular psoriasis in a severely ill patient is described. The patient's clinical course was unaltered by conservative measures, methotrexate alone or etretinate (Ro 10-9359) alone. However, with combination therapy, rapid remission of the acute phase of the illness was achieved, with eventual clearing of the skin. Methotrexate dosing was tapered, and the patient continued to do well on etretinate alone. The relatively rapid onset of action of methotrexate for treatment during the acute phase may allow time for etretinate to exert its effect and permit the use of this relatively benign drug in the long-term phase of treatment.