A Case of Guttate Psoriasis showing Erythema Multiforme-like Exanthema as an Initial Eruption

Abstract

A 38-year-old male presented with edematous macules, papules and target lesions over the whole body and pharyngeal pain. A toxic eruption was suspected, but treatment with oral administration of corticosteroids and antibiotics was unsuccessful. Ten days later, the lesions developed into erythemas with thick scales. Histological examination showed mounds of parakeratosis with neutrophils and dilated blood vessels at the tips of the dermal papillae, compatible with early psoriasis. At this point, a diagnosis of guttate psoriasis was made. Therefore, oral PUVA therapy was started, and the skin lesions disappeared 2 months later. The edematous erytemas at the beginning of the disease suggested an initial psoriatic eruption.