The correct answer is E. Topical irritants. 

In generalized pustular psoriasis, the infiltration of neutrophils dominates the histologic picture, while erythema and the appearance of sterile pustules dominate the clinical picture. It is an unusual manifestation of psoriasis, and triggering factors include pregnancy, rapid tapering of corticosteroids (or other systemic therapies), hypocalcemia, infections, and, in the case of the localized pattern, topical irritants. Recently, biallelic mutations in the gene encoding the IL-36 receptor antagonist (leading to increased production of IL-8 and enhanced responses to IL-1β) have been identified in a subset of patients with generalized pustular psoriasis. Generalized pustular psoriasis during pregnancy is also referred to as impetigo herpetiformis.

Topical irritants are not triggering factors in the generalized variant of psoriasis.

References: Odom, RB. Andrews’ diseases of the skin, 9th Edition. Philadelphia: WB Saunders, 2000; 220.

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