A 56-year-old white woman with pustular psoriasis was studied for three months in our Clinical Research Center. The patient was found to have persistent hypocalcemia which was related to chronic hypoalbuminemia. The patient was found to be metabolizing serum albumin at an abnormally rapid rate. Electron microscopic examination of her skin lesions and uninvolved skin revealed abnormal vessels with markedly attenuated endothelial walls and gaps between the endothelial cells. These vessels are thought to represent an abnormality in the arterial capillary segment of the microcirculation. The gaps are thought to be a major contribution to the production of chronic hypoalbuminemia.
Braverman IM, Cohen I, O'Keefe E. Metabolic and Ultrastructural Studies in a Patient With Pustular Psoriasis (von Zumbusch). Arch Dermatol. 1972;105(2):189-196. doi:10.1001/archderm.1972.01620050003001