Persistence of pustular psoriasis and psoriatic arthritis: A male patient's two-year experience with methylprednisolone and doxycycline therapy

Generalized pustular psoriasis (GPP) is a rare and severe inflammatory dermatosis characterized by sudden eruptions of sterile pustules and possible systemic involvement. Its variable presentation and lack of standardized diagnostic criteria often complicate timely recognition. We report a 32-year-old male with a three-month history of widespread erythematous, scaly, and pruritic lesions, progressing from the lower extremities to nearly the entire body. He had received long-term methylprednisolone and doxycycline for arthritis. Examination revealed extensive erythematous macules with thick scales affecting 64% body surface area, with elevated inflammatory markers (PCT 50.8, leukocytes 12.85, CRP 19.93). Microbiology was negative, and skin biopsy confirmed pustular psoriasis. Severity scores showed GPPASI 7.5, JDA-GPPSI 9, GPPGA 8, and DLQI 22. The patient improved after four weeks of intravenous fluids, methotrexate, and topical therapy. This case highlights the heterogeneous presentation of GPP and the role of standardized assessment tools in evaluating treatment response.