Induction of generalized pustular psoriasis by topical use of betamethasone-dipropionate ointment in psoriasis.

Three patients with chronic discoid psoriasis are described as having a generalized pustular eruption provoked by the topical use of betamethasone-dipropionate ointment (0.05%) over extensive skin areas for two or three weeks. All the lesions were nearly healed when the rash erupted. It is suggested that the potent topical steroid was absorbed through the damaged psoriatic skin, resulting in a systemic effect and a generalized pustular psoriasis (GPP). It was estimated that the patients absorbed at least 1.5 mg betamethasone per day during the application period.(i.e. 3 tablets of CelestonaR 0.5 mg). Just as steroids systemically are contraindicated in chronic discoid psoriasis by the risk of GPP, potent topical steroids must be avoided over large psoriatic skin areas.