Severe initial manifestations of psoriasis in staphylococcal infections

Psoriasis vulgaris is a chronic disease with certain restrictions of life quality, but rarely life threatening. However, psoriatic erythroderma or pustular psoriasis can be a diagnostic or therapeutic challenge, especially when it arises as the primary manifestation of disease. Here we report on two patients with severe clinical course of pustular psoriasis or psoriatic erythroderma, both possibly induced by Staphylococcus aureus. This microorganism was cultivated from skin scrapings in both patients, in the patient with pustular psoriasis from the blood, and in the patient with erythroderma from the nose. Both patients had anti-staphylolysin antibodies. Both patients showed resolution of their disease only by the action of systemic antibiotics. We suggest that staphylococcal superantigens which activate T-cells might play an important role in severe psoriasis by inducing a systemic Kobner phenomenon and thus a progression of disease.