Pustular Psoriasis - Symptoms and Treatment

Pustular psoriasis is an uncommon form of psoriasis. The skin under and around these bumps is red. Primarily seen in adults, pustular psoriasis is characterized by white pustules surrounded by red skin. It appears as red, scaled plaques most commonly on the elbows, knees and scalp. Pustular Psoriasis often affects the areas of the feet and the hands and usually manifests itself as small bumps or Pustules on the surface of the skin that contain a slightly sticky clear fluid. Pustular psoriasis also can be generalized, covering most of the body. Another form of pustular psoriasis is localised pustular psoriasis, which appears on the hands or feet. Pustular psoriasis is an uncommon form of psoriasis consisting of widespread pustules on an erythematous background. Cutaneous lesions characteristic of psoriasis vulgaris may be present before, during, or after an acute pustular episode. The acute generalized type accompanied by fever and toxicity also is termed the von Zumbusch variant. Pustular Psoriasis is considered to be one of the rarer forms of the disease but can also prove to be one of the most dangerous as it can affect the body both internally and externally. The extent of psoriasis and how it affects the individual varies from person to person. The affected areas become red and scaly, cracks may form and these are often painful.

Psoriasis is a common papulosquamous skin disease that may be associated with a seronegative spondyloarthropathy. Generalized pustular psoriasis is often triggered by stopping topical or oral steroids. Any person with psoriasis who is prescribed oral corticosteroids for another condition should discuss their use with a dermatologist before taking them. Psoriasis is present due to increased epidermal proliferation from excessive cell division in the basal layers. The literature reviewed suggests that 1-3% of most world population suffer from Psoriasis and it is most often seen between the ages of 15-40 years. The condition is lifelong and characterised by chronic, recurrent exacerbations and remissions that are emotional and physically stressful. Psoriasis generally has a benign and chronic course but in its pustular or erythrodermic forms it may exceptionally give rise to severe or even fatal complications. Pustular Psoriasis is a disease in which blisters of non-infectious pus appear on the skin, and may affect large or small areas of the body. It can limit to one part of the body or can be widespread. Pustular psoriasis affects all races. Children aged 2-10 years can be affected, but this is rare. The average age of people with pustular psoriasis is 50 years. The pustules often start their cycle with a yellowish colour as a result of white blood cells building up inside them.

Causes of Pustular Psoriasis

Common Causes of Pustular Psoriasis :

• Withdrawal of systemic steroids.
• Hypocalcemia.
• Infections.
• Cholestatic jaundice.
• Sunlight or phototherapy.
• Idiopathic in many patients.

Symptoms of Pustular Psoriasis

Some common Symptoms of Pustular Psoriasis :

• Itching.
• Small scaling spots.
• Joint pain or aching.
• Small red dots on the skin.
• Dry, cracked skin that may bleed.
• Thickened, pitted or ridged nailsl .
• Red patches of skin covered with silvery scales.
• Rashes on the genitals or in the skin folds.

Treatment of Pustular Psoriasis

Some common Treatment of Pustular Psoriasis :

• Topical (applied to the skin) � Mild to moderate psoriasis.
• Oral retinoid such as acitretin , derived from vitamin A.
• Phototherapy (light, usually ultraviolet, applied to the skin) � Moderate to severe psoriasis.
• Sometimes it is necessary to restart corticosteroids, usually temporarily.
• Systemic (taken orally or by injection or infusion) � Moderate, severe or disabling psoriasis.
• Other medications such as methotrexate , colchicine , ciclosporin , tioguanine and hydroxyurea have been used with some success.
• Phototherapy (ultraviolet radiation), especially in combination with oral psoralens. This is usually started once the patient has been stabilised on acitretin.

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