TibotSkin ProblemPsoriasisPustular Psoriasis

Pustular Psoriasis

Pustular psoriasis is a skin disease which is an uncommon form of psoriasis consisting of widespread pustules on an erythematous background. It is clearly defined, raised bumps on the skin that are filled with pus (pustules). The skin under and around these bumps is reddish.

Psoriasis is an immune condition which affects the skin and sometimes the joints. It occurs when the skin renewal process speeds up, leading to a buildup of excess skin cells that form into raised plaques.

The plaques can be flaky, scaly, red, and itchy. Psoriasis can affect almost any area of the body, including the scalp, hands, feet, and genitals. Different types of psoriasis can affect different areas.

In pustular psoriasis, small white or yellow blisters or pustules appear on the top of very red skin. The pus is composed of white blood cells. On darker skin, instead of red patches, the patches are darker in color.

Pustular psoriasis may result in erythroderma. Cutaneous lesions characteristic of psoriasis vulgaris can be present before, during, or after an acute pustular episode.

Pustular Psoriasis

Pustular psoriasis affects all races. Globally, a female predominance has been reported. The female male ratio is 3:2 in children. The average age among adult patients with pustular psoriasis is reported between 48 and 50 years. The average age of onset of acute generalized pustular psoriasis is 41 years. Children aged 6 weeks to 10 years can be affected, though rarely. Children who don’t develop secondary infection have a good prognosis.

Types:

Von Zumbusch: It can appear abruptly on the skin. It is characterized by widespread areas of reddened skin, which become painful and tender. Children rarely develop Von Zumbusch pustular psoriasis, but when it does happen it is often the first psoriasis flare and may have a better outcome than in adults. This form can be life-threatening and requires immediate medical care.

Palmoplantar pustulosis (PPP): It causes pustules on the palms of the hand and soles of the feet. It commonly affects the base of the thumb and the sides of the heels.

Acropustulosis: It is a rare type of psoriasis characterized by skin lesions on the ends of the fingers and sometimes on the toes. The eruption occasionally starts after an injury to the skin or infection. It can be painful and disabling, and cause deformity of the nails even bone damage.

 

Pustular psoriasis is primarily seen in adults. It may be limited to certain areas of the body, like: the hands and feet. Generalized pustular psoriasis also can cover most of the body. It tends to go in a cycle with reddening of the skin followed by pustules and scaling.

Pustular psoriasis is an autoimmune disease. The exact cause of pustular psoriasis is not known, but in some cases it is believed to be due to gene mutations. It is thought to be hereditary and it tends to run in families. Pustular psoriasis leads to the formation of small blisters on the surface of reddened skin.

A mutation, or change, in one of two specific genes (IL36RN or CARD14), may make more likely to get pustular psoriasis. If have one of these gene mutations, one of those triggers could set off a flare. Triggering factor for pustular psoriasis include:

  • Internal medications,
  • Irritating topical agents,
  • Overexposure to ultraviolet light,
  • Pregnancy,
  • Systemic steroids,
  • Infections,
  • Emotional stress,
  • Sudden withdrawal of systemic medications or potent topical steroids,
  • Skin injuries.

Women of pregnancy (third trimester) are at risk of pustular psoriasis. This is because pregnancy involves changes in hormones, which sometimes cause confusion and malfunctions within the immune system. This rare condition, also called impetigo herpetiformis, usually resolves after pregnancy. Pustular psoriasis can also occur in women who have never had psoriasis symptoms before.

Women who are receiving treatment for psoriasis and become pregnant should see their doctor for guidance on which medication to use to prevent adverse effects during pregnancy and nursing.

Treatment may include antibiotics, rehydration, and topical creams. If these don’t work, may add an oral steroid to relieve symptoms. It is not unusual for doctors to combine or rotate treatments for pustular psoriasis due to the potential side effects of systemic medications and phototherapy. A combination of acitretin and methotrexate can send pustular psoriasis into rapid remission and eventual clear the skin. These medications do not need to be combined to be effective for pustular psoriasis. Treatments for specific types of pustular psoriasis include:

Generalized pustular psoriasis: The goal of treatment is to prevent infection and fluid loss, stabilize the body’s temperature and restore the skin’s chemical balance. Acitretin, cyclosporine, methotrexate, oral PUVA (the light-sensitizing drug psoralen plus ultraviolet light A) and TNF-alpha blockers, such as infliximab, are prescribed.

Localized pustular psoriasis: This form can be stubborn to treat. Topical treatments are usually prescribed first. Doctor may prescribe PUVA, ultraviolet light B (UVB), acitretin, methotrexate or cyclosporine.

Von Zumbusch: Treatment often consists of acitretin, cyclosporine or methotrexate. Oral steroids for those who do not respond to other treatments or who have become very ill. PUVA may be used the severe stage of pustule and redness has passed.

Palmoplantar pustulosis: Topical treatment first for palmoplantar pustulosis and then consider other options, like: PUVA, UVB, acitretin, methotrexate or cyclosporine.

Acropustulosis: Occlusion of topical preparations may help some people. Some people have had success using systemic medications to clear lesions and restore the nails.

Visit a doctor if notice unusual skin changes. If have a rash, blister, or open sore that does not improve or worsens need to visit a skin specialist.

  • Oxford hand Book of medical Dermatology
  • ABC Of Dermatology
  • Clinical Dermatology
  • Roxburgh’s common skin diseases
  • Andrew’s Diseases of the skin.
TibotSkin ProblemPsoriasisPustular Psoriasis

Pustular Psoriasis

TUI - Tibot Urgency Index

Pustular psoriasis is a skin disease which is an uncommon form of psoriasis consisting of widespread pustules on an erythematous background. It is clearly defined, raised bumps on the skin that are filled with pus (pustules). The skin under and around these bumps is reddish.

Psoriasis is an immune condition which affects the skin and sometimes the joints. It occurs when the skin renewal process speeds up, leading to a buildup of excess skin cells that form into raised plaques.

The plaques can be flaky, scaly, red, and itchy. Psoriasis can affect almost any area of the body, including the scalp, hands, feet, and genitals. Different types of psoriasis can affect different areas.

In pustular psoriasis, small white or yellow blisters or pustules appear on the top of very red skin. The pus is composed of white blood cells. On darker skin, instead of red patches, the patches are darker in color.

Pustular psoriasis may result in erythroderma. Cutaneous lesions characteristic of psoriasis vulgaris can be present before, during, or after an acute pustular episode.

Pustular Psoriasis

Pustular psoriasis affects all races. Globally, a female predominance has been reported. The female male ratio is 3:2 in children. The average age among adult patients with pustular psoriasis is reported between 48 and 50 years. The average age of onset of acute generalized pustular psoriasis is 41 years. Children aged 6 weeks to 10 years can be affected, though rarely. Children who don’t develop secondary infection have a good prognosis.

Types:

Von Zumbusch: It can appear abruptly on the skin. It is characterized by widespread areas of reddened skin, which become painful and tender. Children rarely develop Von Zumbusch pustular psoriasis, but when it does happen it is often the first psoriasis flare and may have a better outcome than in adults. This form can be life-threatening and requires immediate medical care.

Palmoplantar pustulosis (PPP): It causes pustules on the palms of the hand and soles of the feet. It commonly affects the base of the thumb and the sides of the heels.

Acropustulosis: It is a rare type of psoriasis characterized by skin lesions on the ends of the fingers and sometimes on the toes. The eruption occasionally starts after an injury to the skin or infection. It can be painful and disabling, and cause deformity of the nails even bone damage.

 

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Dr. Lora Smith

MBBS (Dhaka), DGO (DU) Ex SR. Gynaecologist & Obstetrician

09 606 111 222

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