European consensus statement on phenotypes of pustular psoriasis

Pustular psoriasis (PP) is a group of inflammatory skin conditions characterized by infiltration of neutrophil granulocytes in the epidermis to such an extent that clinically visible sterile pustules develop. Because of clinical co-incidence, PP is currently grouped with psoriasis vulgaris (PV). However, PP and PV are phenotypically different, respond differently to treatments and seem to be distinct on the genetic level. In contrast to PV, the phenotypes of PP are not well defined. Descriptions of each form of PP are discordant among standard dermatology textbooks [Saurat Dermatologie 2016, Rook's Dermatology 2016, Fitzpatrick's 2012 and Braun-Falco 2012], encumbering the collection of phenotypically well-matched groups of patients as well as clinical trials. The European Rare and Severe Psoriasis Expert Network (ERASPEN) was founded to define consensus criteria for diagnosis, deeply phenotype large groups of PP patients, analyse the genetics and pathophysiology and prepare for prospective clinical trials. This work reviews historical aspects of these conditions, new genetic findings and presents our initial considerations on the phenotypes of PP and a consensus classification of clinical phenotypes that will be used as a baseline for further, prospective studies of PP. Generalized pustular psoriasis (GPP) is defined as primary, sterile, macroscopically visible pustules on non-acral skin (excluding cases where pustulation is restricted to psoriatic plaques). GPP can occur with or without systemic inflammation, with or without PV and can either be a relapsing (>1 episode) or persistent (>3 months) condition. Acrodermatitis continua of Hallopeau (ACH) is characterized by primary, persistent (>3 months), sterile, macroscopically visible pustules affecting the nail apparatus. Palmoplantar pustulosis (PPP) has primary, persistent (>3 months), sterile, macroscopically visible pustules on palms and/or soles and can occur with or without PV.

Autoinflammatory pustular neutrophilic diseases

This article provides a new categorization of inflammatory pustular dermatoses in the context of recent genetic and biological insights. Monogenic diseases with pustular phenotypes are discussed, including deficiency of interleukin 1 receptor antagonist, deficiency of the interleukin 36 receptor antagonist, CARD14-associated pustular psoriasis, and pyogenic arthritis, pyoderma gangrenosum, and acne. How these new genetic advancements may inform how previously described pustular diseases are viewed, including pustular psoriasis and its clinical variants, with a focus on historical classification by clinical phenotype, is also discussed.

L’acropustulose infantile

FROM A CLINICAL POINT OF VIEW: Infantile acropustulosis is a rare and little known dermatosis affecting young children. Clinically, it consists of prurigenous vesiculo-pustular lesions characteristically localised on the palms of the hands and the soles of the feet. NO CONFUSION SHOULD EXIST: The principle differential diagnosis is scabies. The other differential diagnosis is neonatal pustulosis. A CONTROVERSIAL HYPOTHESIS: The aetiopathogenesis is unknown, but some cases of infantile acropustulosis set-in in the course of a genuine scabies, which might suggest a hypersensitivity reaction to Sarcoptes scabiei. It is a benign affection, progressing in flares, occasionally provoking severe pruritus. Treatments are disappointing, and the disease heals spontaneously after a few years.

What's new in pediatric dermatology

This report discusses some of the newly described diseases in pediatric dermatology and recent developments in other diseases that are pertinent to this field.

Infantile acropustulosis

Infantile acropustulosis (IA) is a syndrome characterized by recurrent crops of 1- to 2-mm intensely pruritic vesicopustules that are found primarily on the distal extremities of infants. It is reportedly responsive to sulfones and unresponsive to other therapy, but if left untreated spontaneously resolves at about 2 years of age. It is more common in black male patients. The histopathologic findings and clinical course are distinct.