Intertriginous pustular psoriasis

We describe 6 patients who presented during infancy with erythematous papules or pustules localized to the neck and sometimes other intertriginous areas as well. Most of these infants were initially thought to have dermatitis or a bacterial or candidal infection. A biopsy specimen established the diagnosis of pustular psoriasis in 5 of the 6 cases. In 4 cases, the psoriasis became more widespread during the months to years after diagnosis. Treatment included topical therapy in all cases and systemic therapy in 3 cases. Two cases have remained particularly recalcitrant. Pustular psoriasis must be considered in the differential diagnosis of an intertriginous papulopustular eruption in an infant. Pustular psoriasis presenting in the intertriginous areas, and particularly the neck, seems specific to infants and may portend progressive extension to widespread involvement. A limitation is that this was a retrospective case series.