Annular pustular psoriasis (APP) is a rare variant of pustular psoriasis occurring only in about 1-5.4% of children with psoriasis. Pustular psoriasis is triggered by endogenous and exogenous factors. Exogenous factors include stress, upper respiratory tract infection and withdrawal of systemic corticosteroids. This condition usually requires systemic treatment. However, there are still no randomized controlled trials or standardized guidelines proving the advantage of any specific treatment modality over the other. We report a case of a 6-year-old male who presented with diarrhea followed by appearance of erythematous annular plaques with pustules and nail changes. Punch biopsy showed pustular psoriasis. Patient was treated with topical betamethasone valerate and calcipotriol, and there was noted to have no recurrence of skin lesions for 4 months.
Psoriasis

Histoplasmosis is well-characterized as a fungal disease that more commonly occurs in North America, mostly endemic in Ohio and Mississippi river valleys. The clinical spectrum of histoplasmosis ranges from asymptomatic infection to a fatal disease. Progressive disseminated histoplasmosis is typically seen in immunocompromised individuals and presents with non-specific systemic symptoms associated with cutaneous manifestations of papules and nodules.? We report a case of a 28-year old Filipino female with a history of exposure to soil activities months before consult. The patient presented with a 3-week history of erythematous macules, vesicles, and pustules over the face, arms, and trunk, which evolve into papules and plaques with hemorrhagic crusting. Patient was initially diagnosed and treated as a case of varicella but had no improvement with initial management. Histopathologic findings were consistent with histoplasmosis. The patient was started with oral itraconazole, but unexpectedly expired before any improvement in cutaneous symptoms were noted.
Disseminated histoplasmosis ; Itraconazole