Young lady with acral pustulosis and psoriatic arthritis

Mary Nnenda Amaewhule, Chidinma Wekhe


Psoriasis is uncommon in this part of the world, and the pustular variety is even rarer. It is for this reason that the patients are frequently misdiagnosed by their health care providers and presentat late to the dermatologists when complications have already set in. We report a case of a 33 year old female who presented to us with a two year history of pustular eruptions on her hands and feet, pain and swelling of joints in the affected areas and subsequent development of deformities. Prior to her presentation, she has been misdiagnosed as having tuberculosis of the skin as well as leprosy in different hospitals and treated as such with no improvement. On presentation to us, a skin biopsy was done and the specimen sent for histopathology. A diagnosis of pustular psoriasis was made and she was placed on oral methotrexate. She responded to treatment and the lesions resolved in a few weeks except for the joint deformities. This case illustrates the challenges encountered by patients with psoriasis in a resource poor setting like ours as well as the importance of availability of affordable drugs like methotrexate in their management. This is so considering the high cost and non-availability of more modern biologic agents in this part of the world.


Psoriasis, Arthritis, Acropustulosis

Full Text:



Griffiths CE, Barker JN. Psoriasis. In: Burns DA, Breathnach SM, Cox NH, Griffiths CE, eds. Rook′s textbook of dermatology. 8th ed. London: Blackwell Publishing Limited; 2010:20.1-12.

Leder RO, Farber EM. The variable incidence of psoriasis in sub-Saharan Africa. Int J Dermatol. 1997;36:911-9.

Kerschbaumer A, Fenzl KH, Erlacher L, Aletaha D. An overview of psoriatic arthritis- epidemiology, clinical features, pathophysiology and novel treatment targets. Wien Klin Wochenschr. 2016;128(21-22):791-5.

Scarpa R, Peluso R, Atteno M. Clinical presentation of psoriatic arthritis. Reumatismo. 2007;59(Suppl 1):49-51.

Robinson A, Van Vorheese A S, Hsu S. Treatment of pustular psoriasis: from the medical board of the national psoriasis foundation. J Am Acad Dermatol. 2012;67(2):279-88.

Black R L, Brien WM, Vanscott E J, Auerbach R, Eisen A Z, Burim J J. Methotrexate therapy in psoriatric arthritis; double blind study on 21 patients. JAMA. 1964;189:743-7.

Espinoza LR, Zakraoui L, Espinoza CG. Psoriatic arthritis: clinical response to and side effects to methotrexate therapy. J Rheumatol. 1992;19:872-7.

Spadaro A, Riccieri V, Sili SA, Sensi F, Taccari E, Zoppirri A. Comparison of cyclosporin A and methotrexate in the treatment of psoriatic arthritis: A one year prospective study. Clin Exp Rheumatol. 1995;13:589-93.

Abdulghani M, Al Sheik A, Alkhawajah M, Ammoury A, Behrens F, Benchikhi H, et al. Management of psoriasis in Africa andthe Middle-East: A review of current opinions, practice and opportunities for improvement. J Int Med Res. 2011;39(5):1573-88.