Pustular psoriasis is a rare and severe form of psoriasis that involves widespread inflammation of the skin. It appears as small white or yellow pus-filled blisters or pustules.
In pustular psoriasis, the lesions contain pus. The pus consists of white blood cells and is not a sign of infection. On light skin, the affected areas will appear red. On darker skin, the patches may be darker in color.
Pustular psoriasis always needs medical attention, as some types can be life-threatening. A range of therapies can usually clear the symptoms, but they may recur later.
Here are some pictures of the symptoms of pustular psoriasis.
Pustular psoriasis involves widespread areas of inflamed skin and pustules that contain fluid, or pus, which gives them their yellow or cream color. It can be painful.
Pustules that burst or dry up may appear brown or crusty. The red or darkened skin surrounding the pustules may be thick and flaky, and the skin may crack.
The presence of pus does not indicate an infection or bacteria. As with all types of psoriasis, the pustules are not contagious and do not pose a threat to others.
The symptoms will vary to some extent, depending on the type.
Types of pustular psoriasis
- generalized pustular psoriasis (von Zumbusch psoriasis) with widespread symptoms across the body
- palmoplantar pustulosis, which affects the palms of the hands and the soles of the feet
- acrodermatitis continua of Hallopeau, which affects only the ends of the fingers and toes
impetigo herpetiformis, a generalized type of pustular psoriasis that can occur in pregnancy
Generalized pustular psoriasis
According to Dermnet NZ, a person can expect the following to happen:
- First, the skin will become hot and tender, often in skin folds.
- Within 2–3 hours, pustules appear, around 2–3 millimeters in diameter.
- The pustules may start to join together, forming pools of pus.
- Over the next few days, the pus will dry out, leaving a smooth, shiny surface.
- The cycle begins again, with new pustules appearing every few days to weeks.
- As pustules dry out, they may leave scars or keloids.
- In time, with treatment, the symptoms will clear. However, they may flare up again at a later date.
Some people go on to develop erythroderma, a serious condition that may need emergency medical attention.
A person with generalized pustular psoriasis may have additional symptoms, such as:
- fatigue, fever, and a general feeling of being unwell
- appetite loss
- a rapid heart rate
- a furrowed or fissured tongue
- inflammation of the lips
- eye infections
- joint pain
- abdominal discomfort
- nail changes
- swelling in the legs and ankles
Large, yellow pustules
They can develop as follows:
- The skin becomes red.
- Pustules form.
- Scaling occurs, and the skin may crack.
Depending on the severity, some people may find it hard to do everyday tasks, such as walking.
Palmoplantar pustulosis is different from palmoplantar psoriasis. Palmoplantar psoriasis affects the hands and feet but does not form pustules.
Acrodermatitis continua of Hallopeau
This is a rare form of pustular psoriasis that involves painful skin lesions on the ends of the fingers and sometimes the toes. The lesions typically form after an injury in the area. Bone changes may also occur.
Pustular psoriasis of pregnancy (impetigo herpetiformis)
Impetigo herpetiformis is a rare form or pustular psoriasis that can occur in the
The person may have no history of psoriasis, and the condition usually resolves after pregnancy.
Psoriasis is an inflammatory condition that
Doctors do not know why this happens, but specific genetic features might increase the risk of developing pustular psoriasis. Two genes that may play a role are IL36RN and AP1S3.
A person with changes in these genes may be more likely to develop pustular psoriasis after exposure to specific triggers, but not everyone with these genetic features will develop it.
The main factors that appear to trigger pustular psoriasis are:
- having a bacterial or viral infection
- changes in medication use
- a personal or family history of some type of psoriasis
Around 1 in 10 people with pustular psoriasis have a previous history of plaque psoriasis.
Other risk factors include:
- overexposure to UV light, for example, sunlight or light therapy
- an electrolyte imbalance
- stem cell transplantation
Pustular psoriasis is not contagious. One person cannot pass it on to another.
Black people often face inequality when it comes to health issues, including psoriasis. Here, read about one woman’s experience.
A dermatologist can usually identify pustular psoriasis by the type of lesions that appear on the skin, but tests can also confirm the diagnosis and identify possible complications.
Pustular psoriasis can be challenging to treat.
Treatment will vary between individuals, depending on their symptoms. A person may need to try more than one treatment or a combination of therapies before finding a suitable one.
Damage to the skin can result in a loss of fluid and internal damage. Depending on how severe symptoms are, a person may need to spend time in the hospital.
Topical therapies may help manage symptoms, especially for localized symptoms. However, anyone with generalized symptoms will also need systemic treatment.
Topical options may include:
- compresses containing suitable topical therapies
- topical corticosteroids, such as hydrocortisone, to apply directly to the skin
- coal tar or salicylic acid to help manage scaling
- emollients and moisturizers to help prevent cracking
Individuals should check first with a doctor before using any therapy for pustular psoriasis.
Other tips that may help manage pustular psoriasis at home include:
- getting enough rest
- drinking plenty of fluids to prevent dehydration
- avoiding excessive heat and other potential triggers
- taking over-the-counter medication to manage joint pain and fever
A doctor may prescribe the following medications:
- antibiotics for a confirmed or suspected infection
- systemic corticosteroids
- cyclosporine (Sandimmune)
- biologic medications, such as etanercept (Enbrel) or adalimumab (Humira)
- topical corticosteroids, calcipotriene, or tacrolimus for localized symptoms
- possibly early delivery the case of impetigo herpetiformis during pregnancy
Doctors may combine or rotate treatment, depending on any side effects and how the symptoms respond. Combining medications may help clear the skin and bring about remission.
For people who experience frequent flares or moderate to severe symptoms, current guidelines recommend using a biologic treatment.
Biologic and biosimilar drugs can help resolve the underlying problem that leads to skin symptoms by targeting specific genes that affect how the immune system works.
They can reduce the risk of flares and the severity of symptoms. A doctor may give it as an injection or an infusion. Some types are suitable for use at home.
Some people with generalized pustular psoriasis may need to spend time in the hospital.
Skin damage can result in fluid loss, and this can lead to dehydration and electrolyte imbalances. If this happens, it can put a strain on the heart and kidneys, especially in older adults.
Treatment will aim to:
- restore the skin’s protective function and chemical balance
- provide rehydration and prevent fluid loss
- stabilize body temperature
- improve a person’s comfort levels
- provide medications to help bring about remission
Pustular psoriasis usually needs medical treatment, but some home remedies may help soothe the skin and relieve irritation and itching.
Possible options include:
- bathing in salt water
- taking oatmeal baths
- using an oil-rich moisturizer to keep the skin moist and possibly prevent peeling
Skin care is essential because blistering increases the risk that bacteria will enter the skin. Keeping the skin clean and moisturized can help reduce the risk of infection.
It is not possible to prevent a condition that results from a genetic change, but some lifestyle choices may reduce the risk of pustular psoriasis occurring.
Psoriasis is a long-term condition. Most people will continue to experience flares, but medication and lifestyle options can help to reduce the risk and severity of symptoms.
People with generalized pustular psoriasis
Here are some questions people often ask about pustular psoriasis.
What triggers pustular psoriasis?
People with psoriasis appear to have genetic features that make symptoms more likely to occur, but some triggers can increase the risk. They include certain infections, stress, and stopping or starting certain medications.
Does pustular psoriasis ever go away?
Treatment can lead to remission, but the symptoms may recur. Following a treatment plan and avoiding potential triggers, where possible, can reduce the risk of a recurrence. If a person without a history of psoriasis has impetigo herpetiformis during pregnancy, it will most likely resolve after delivery.
How serious is pustular psoriasis?
Anyone with pustular psoriasis should seek medical help as soon as possible, as some types can be life-threatening. Medical and other treatment can often clear the symptoms at home, but some people may need hospital treatment.
Generalized pustular psoriasis can also affect other body systems. For this reason, it is essential to follow a doctor’s advice and treatment plan.
Pustular psoriasis is a potentially serious psoriatic disease that involves pus-filled bumps on the skin. It is not contagious but stems from a genetic condition. Certain triggers — such as an infection or change of medication — can lead to symptoms.
Localized pustular psoriasis affects only part of the body, but generalized pustular psoriasis can affect other body systems. It can become life-threatening.
A doctor will work with the person to make a treatment plan. It is essential to follow the doctor’s instructions and seek further advice if symptoms change or worsen or if a medication appears to trigger adverse effects.
Learn more about different types of psoriasis
Find out about these different types of psoriasis: