Psoriasis vulgaris and acute guttate psoriasis in a family

A 33-year-old man (Case 1) developed scaling and erythema on the extensor s ide of his extremities, head, and back, 3 years before his first visit to o ur hospital. The lesions spread out to form several plaques and became pers istent (Fig. la). Serum antistreptolysin O (ASO) was within the normal rang e and a pharyngeal culture showed normal flora. Histologic findings were co mpatible with psoriasis vulgaris (Fig. Ib). Topical steroid therapy was eff ective; however, scaling and erythema persisted. The 8-year-old daughter (Case 2) of Case 1 had suffered severe tonsillitis 2 months prior to the skin eruptions. Numerous rain drop-like scaly papules appeared on her legs and generalized rapidly (Fig. 2a). Her tonsils were s wollen and reddish. Streptococcus pyogenes was detected by pharyngeal smear . The ASO value was at a high level. Histologic examination showed slightly elongated rete ridges, focal lack of the granular layer, parakeratosis, mi ld spongiosis, and exostosis of neutrophils (Fig.2b). She was diagnosed wit h acute guttate psoriasis. Administration of oral antimicrobials reduced th e ASO value and led to remission of the disease. After 1 month of antimicro bial treatment, the erythematous papules disappeared. The human leukocyte antigen (HLA) typing of the father was HLA-A24, A31, B7 , B39, and Cw7, and that of the daughter was HLA-A24, A31, B39, and Cw7. Bo th possessed HLA-A24, B39, and Cw7. The HLA typing of other family members was also studied. The mother had HLA-A11, A24, B39, B62, Cw4, and Cw7, and her son had HLA-A11, A24, 87, B62, Cw4, and Cw7. The result of HLA typing i s shown in Table 1. Lymphocyte stimulating test was performed using heat-killed S. pyogenes whi ch were boiled at 70 degreesC for 10 min and sonicated. The stimulation ind ex was twofold higher in the daughter than in the father(fig.3).