Von Zumbusch’s pustular psoriasis associated with oral terbinafine

Adverse skin reactions have been reported in 2.7% of patients receiving oral terbinafine. Less common but life-threatening reactions include acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome, toxic epidermal necrolysis, exacerbation or induction of psoriasis. We report a case of a 28 year-old woman with no history of psoriasis, the patient presented generalized pustular eruption, erythroderma, prolonged fever and altered general conditions, associated with initiation of oral terbinafine. The histological analysis of the cutaneous biopsy was compatible with pustular psoriasis. The intake of terbinafine was discontinued and treatment by acitretin 25 mg/day associated with emollient cream was started. The evolution was marked by resolution of skin eruption and disappearance of the fever in a few days. The complete remission was reached 2 months later. The diagnosis of severe generalized pustular psoriasis (GPP), type Von Zumbusch associated with initiation of oral terbinafine was made. The present case indicates that terbinafine is a drug that may be associated with the development of psoriasis de novo or its exacerbation.