Fig. 1.

a Pedigree of the case. The present case (I-1) had had psoriasis vulgaris for 31 years and developed GPP at 78 years of age. Her brother (I-2) had psoriasis vulgaris and her daughter (II-1) had arthritis with a high titer of ANA. Her niece (II-2) had psoriatic arthritis. b Clinical course of the lesion on her right lower leg before and after GMA. Left: The patient showed diffuse edema and severe erythema and desquamations at her first visit, 1 week before treatment with GMA. The severity score of GPP was 12. Center: Edema, erythemas and scales were markedly improved at 6 days after three sessions of GMA. The severity score was 5. Right: The skin conditions were well controlled at 19 days after the last GMA session. The severity score was 4.