We have observed two patients with generalized pustular psoriasis, an index case and his maternal uncle, and noted the likely presence of the condition in an additional uncle and grandmother. Early onset of the disease in childhood was noted, as well as usual survival of affected patients into adult life. Isolation of β -hemolytic streptococci from the skin of one of our patients, and development of pustular lesions at the site of an intradermal streptococcal skin test, followed by a generalized exacerbation of pustular psoriasis, suggested streptococcal infections were significant aggravating factors. A localized sunburn reaction also reproduced, clinically and histologically, typical lesions of pustular psoriasis in this patient. Serum calcium levels were typically decreased in our patients and were related to hypoalbuminemia. Levels of parathyroid hormone were normal. The values for IgG were significantly decreased.
Landry M, Muller SA. Generalized Pustular PsoriasisObservations on the Course of the Disease in a Familial Occurrence. Arch Dermatol. 1972;105(5):711-716. doi:10.1001/archderm.1972.01620080037010