Rarely pemphigus foliaceus could be associated with generalized pustular psoriasis. A 66-year-old woman with diffuseflaccid bullae and erosions of pemphigus foliaceus underwent two sessions of pulse therapy of corticosteroid and oralprednisolone during the interval time. Two weeks after the second session of pulse therapy with improvement of thelesions, during tapered dosage of oral prednisolone, facial annular erythematous lesions appeared and were superimposedby generalized pustular eruptions. Skin biopsy of pustular lesions showed pustular psoriasis so intramuscularmethotrexate was added. Two years later, during decreasing dosage of methotrexate and prednisolone, she had eruptiverecurrence of pustules and flaccid bullae associated with erythroderma and fever which were controlled with increasingdosage of corticosteroid and starting oral retinoid. These hypotheses may explain co-occurring pemphigus foliaceusand pustular psoriasis: decreasing dosage of corticosteroid, interleukin-8 overproduction in keratinocytes and increasedactivity of plasminogen activator in skin lesions.
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