Juvenile generalized pustular psoriasis

A 4-year-old boy had a generalized, confluent, pustular eruption on an erythematous base of three weeks' duration. He was febrile and toxic. He had had a similar problem at age 5 months that lasted for about four weeks. The child was initially treated conservatively, but later developed erythroderma and became increasingly toxic. This necessitated administration of oral methotrexate 2.5 mg/day at weekly intervals. After two pulses there was marked improvement in his psoriasis.