SUMMARY.— Treatment with systemically administered corticosteroids and folio acid antagonists was evaluated in 104 patients with generalized pustular psoriasis. Seventy‐three were given steroids; the remainder were not. Seventeen patients died. There were more deaths and fewer lasting remissions in the steroid‐treated group. Although steroids can control the pustular phase, the incidence and severity ot side effects seriously reduced their long‐term value. Steroid treated patients tended to suffer increasingly severe generalized pustular relapses often precipitated by attempted withdrawal of the steroid. Satisfactory control with minimal or no side effects was achieved in only 12 out of 73 patients. Forty‐seven patients received folic acid antagonists, predominantly methotrexate. In 37 the pustules were cleared by the drug at some stage. Response to methotrexate was less satisfactory in patients previously treated with steroids, but it was of particular value in covering steroid withdrawal in patients whose disease had become refractory to the latter or in whom serious steroid side effects had developed. There were 8 deaths among the methotrexate treated patients, 3 of which were directly attributable to the drug. In 16 other patients treatment had to be discontinued because of side effects. Methotrexate w as responsible mainly for the minor short‐term complications and steroids for the more serious long‐term ones. The outlook for spontaneous and long‐lasting remission was much greater in younger patients and in those with a previous history of long‐standing ordinary psoriasis.
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RYAN et al. (1969) studied this question.