A patient with psoriasis was staed on systemic steroids. After stopping treatment patient developed generalized pustules all over his body, the most likely cause is:
## **Core Concept**
The question revolves around the concept of **psoriatic rebound phenomenon** or **steroid withdrawal reaction**, which can occur in patients with psoriasis who are abruptly stopped from systemic steroids. This phenomenon is particularly associated with severe forms of psoriasis.
## **Why the Correct Answer is Right**
The correct answer, **Psoriatic pustular eruption**, also known as **generalized pustular psoriasis**, is a severe form of psoriasis characterized by the widespread appearance of pustules on the body. When systemic steroids are abruptly discontinued in patients with severe psoriasis, it can trigger a severe rebound effect, leading to generalized pustular psoriasis. This condition is life-threatening and requires immediate medical attention.
## **Why Each Wrong Option is Incorrect**
- **Option A: Exacerbation of psoriasis** - While this could be a consequence of stopping treatment, it doesn't specifically describe the severe reaction of generalized pustules.
- **Option B: Erythrodermic psoriasis** - This is a form of psoriasis characterized by widespread redness and scaly skin, but it doesn't specifically involve pustules.
- **Option C: Psoriatic arthritis** - This is a form of arthritis associated with psoriasis but does not describe a skin reaction.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **abrupt discontinuation of systemic steroids in patients with severe psoriasis can lead to generalized pustular psoriasis**, a medical emergency. Clinicians should taper steroids gradually in such patients to prevent this severe rebound effect.
## **Correct Answer:** D. Psoriatic pustular eruption.