Pustular psoriasis (PP) is rare in children. The small number of reported cases makes deciding on treatment and follow-up challenging. The current study was an evaluation of treatment approaches and courses of PP in 18 children diagnosed and followed over a 20-year period. From 1992 to 2011 we treated 1,447 children with psoriasis, 18 of whom had PP. Follow-up was 2 to 19 years. At the time of initial manifestation of PP, our patients were 1.5 months to 16 years old. Seven patients had a previous history of psoriasis vulgaris. Three children entered long-term remission after one pustular attack, 10 developed psoriasis vulgaris, 2 are currently under treatment, and 3 were lost to follow-up. Treatment with acitretin, cyclosporine, or methotrexate was efficacious and well tolerated. PP is rare, but according to our experience, it has a good prognosis in children.