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Generalized pustular psoriasis (GPP) is a rare form of psoriasis with occasional episodes of acute exacerbations. In periods of exacerbation, patients are treated orally with corticosteroid, retinoids, or cyclosporine. In cases that are not amenable to systemic administration, topical corticosteroid or cholecalciferol therapy may be used. There is no established therapy for GPP that has been proved to be safe and effective. The systemic administration of tacrolimus is known to be effective1 but has not been approved for the treatment of psoriasis. Topical tacrolimus is widely accepted for the treatment of atopic dermatitis2 but not for psoriasis vulgaris.3 The effect of topical tacrolimus therapy for GPP is not yet known.
A, The legs show marked edema and diffuse desquamated erythema with pustules on the peripheral areas. B, One week of topical treatment with tacrolimus on the left leg shows dramatic effects. The right leg was treated with calcipotriol.
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