Pustular psoriasis is a type of psoriasis that leads to raised white blisters filled with noninfectious pus (pustules). The surrounding skin is often red and irritated.
Like all forms of psoriasis, pustular psoriasis is NOT contagious.
Pustular psoriasis accounts for fewer than 5% of psoriasis cases and occurs most commonly in the elderly.
Types of Pustular Psoriasis
There are two main types of pustular psoriasis:
- Localized (palmoplantar pustulosis, or acropustulosis)
- Generalized (Von Zumbusch)
The localized type of pustular psoriasis appears on specific regions of the body in periodic cycles. When it occurs on the hands and feet it is called palmoplantar pustulosis, or PPP. When it occurs on the fingers or toes, it is called acropustulosis. The eruption occasionally starts after an injury to the skin or infection. Often the lesions are painful and disabling, producing deformity of the nails.
The generalized type is called Von Zumbusch pustular psoriasis. This is a more serious condition, because of its widespread impact on the skin and because the repeated flares may last weeks.
Von Zumbusch pustular psoriasis can appear abruptly on the skin as widespread areas of reddened, painful and tender skin. Within hours, pustules start appear. Other symptoms of generalized pustular psoriasis include fevers, chills, and weakness.
Generlized pustular psoriasis can be a medical emergency because the disrupted skin can lead to fluid loss (dehydration), chemical imbalances, and infection. Medical care must be sought immediately from a doctor or, if one is not available, from an emergency room.
Treatment of Pustular Psoriasis
Pustular psoriasis may be treated with one or more of the following medications:
- Oral retinoids (Soriatane®)
Triggers of Pustular Psoriasis
The most common trigger of pustular psoriasis is the rapid withdrawal of oral corticosteroids (prednisone). For this reason, oral corticosteroids are used very carefully in people with psoriasis, and if used, they are withdrawn slowly.
Other triggers include pregnancy, sunburn, infections or stress.
Images courtesy of The National Psoriasis Foundation.