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.
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Causes of pustular psoriasis
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.
Factors that can trigger pustular psoriasis include:
- Internal medications
- Irritating topical agents
- Overexposure to ultraviolet light
- Systemic steroids
- Emotional stress
- Sudden withdrawal of systemic medications or potent topical steroids
- Skin injuries
Women in the third trimester of pregnancy 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.
Developing psoriasis that stems from gene mutations or heredity cannot be prevented, but some lifestyle changes can help prevent outbreaks.
Eating a balanced diet, getting enough rest, and controlling exposure to sunlight can help to prevent pustular psoriasis.
A person that develops any symptoms of psoriasis should see a doctor.
Different types of pustular psoriasis
There are different types of pustular psoriasis.
Palmoplantar pustulosis (PPP) and acrodermatitis continua of Hallopeau (ACH) affect only the palms of the hands and or soles of the feet.
Generalized pustular psoriasis (GPP), also known as von Zumbusch psoriasis, tends to be more widespread across the body.
In each type of pustular psoriasis, the pustules are filled with fluid, which gives them their yellow or cream color. Pustules that burst or dry up may appear brown or crusty. The red or darkened skin surrounding the pustules can be thick and flaky. This skin is often prone to cracking.
The pus-filled pustules do 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.
Though dermatologists can normally identify pustular psoriasis by the type of lesions on the skin, tests are available that can confirm the diagnosis and identify potential complications.
- Laboratory tests for bacterial infections
- Skin biopsy
- Blood count
- Kidney and liver function
- Levels of electrolytes and minerals
Medication for all types of pustular psoriasis includes topical steroid creams or emollients, which an individual applies to the affected area, and systemic medications, which a person takes by mouth or by injection.
Methotrexate is a systemic medication that is commonly prescribed for pustular psoriasis. However, each type of pustular psoriasis has slightly different treatments.
Generalized pustular psoriasis
This is a rare form of pustular psoriasis, especially rare in children, but is very serious. It can make a person feel very ill and it requires urgent medical care.
GPP causes blisters and reddened skin to appear all over the body.
A person with GPP will have pustules, redness, and peeling skin all over their body. The individual will generally be admitted to the hospital under the care of dermatologists until their symptoms improve.
It can occur suddenly and there may be a number of symptoms, including:
- Fever and shivers
- Intense itching
- Rapid pulse
- Dehydration and exhaustion
- Muscle weakness and joint pain
- Weight loss
During this time period, a person's skin can be very sore and fragile. These outbreaks of GPP can sometimes be followed by milder flares of psoriasis.
People with GPP will need immediate medical attention and hospitalization may be necessary. The treatment aims to restore the skin's protective function and chemical balance to prevent loss of fluid and stabilize the body's temperature.
GPP can give rise to life-threatening complications. If chemical imbalances occur, there may be additional strain on the heart and kidneys, especially in older adults.
Medications for GPP include:
- Antibiotics for confirmed or suspected infection
- Systemic corticosteroids
- Ciclosporin, used if symptoms need to be controlled quickly
- Biologic agents
A person with PPP will develop large, yellow pustules in the fleshy areas of their hands and feet. Pustular psoriasis can be painful, but PPP can be especially painful as it affects the palms and soles.
Palmoplantar pustulosis can be treated by applying medicine to affected areas of the body.
Outbreaks typically follow a specific cycle, starting with reddening of the skin, followed by the formation of pustules, and then scaling of the skin.
The skin will sometimes crack and this can lead to discomfort. Depending on the severity, some people with PPP have difficulty fulfilling everyday tasks. Sometimes, everyday activities such as walking become difficult.
According to the Psoriasis and Psoriatic Arthritis Alliance, roughly 5 percent of people with psoriasis are affected by PPP. It typically affects people between the ages of 20 and 60 years, and it is more common in people who smoke. Infection and stress are the most common triggers.
Most types of pustular psoriasis are difficult to treat. People who have this condition should make sure they see a dermatologist regularly to ensure the best treatment.
Initial treatment for PPP frequently involves topical therapies, including strong topical steroids applied to the palms and soles. Coal tar or salicylic acid may help with scaling. Regular application of an emollient can help to prevent the skin area from cracking, which helps to keep the palms and soles more flexible.
People with PPP may find that applying topical creams to their hands and feet regularly makes working and other activities difficult, so light therapy or oral medications may be given. A dermatologist may offer these treatments in combination or separately.
Over-the-counter topical creams containing salicylic acid or hydrocortisone may help some people, but individuals should check with a doctor before using.
Acrodermatitis continua of Hallopeau
A person with APH, a rare form of pustular psoriasis, will develop skin lesions on the ends of their fingers and sometimes on their toes.
The lesions typically form after a localized physical trauma. They are painful, and the nail area can become deformed. In some people, bone changes may occur.
Combination therapy may be recommended to people who have ACH because this condition is often resistant to topical and systemic treatments.
With all types of pustular psoriasis, doctors frequently combine or rotate treatments, depending on how the patient responds and the potential side effects. Sometimes, combining medications can help to achieve a remission. Combination medication may also clear the patient's skin.
Medical treatment is recommended for people who have pustular psoriasis, but some natural home remedies may be beneficial for some patients. These treatments may help to soothe and heal the affected areas. They can also help relieve itching.
- Tree bark extract
- Compresses using bland, non-irritating medications
- Salt water solutions or salt water baths
- Oatmeal baths
- Aloe vera gel can help to reduce redness and itching
- Applying an oil-rich moisturizer can keep the skin moist and possibly prevent peeling
If scales form, they can be removed with a soft cloth.
Skin care is important because the blisters from psoriasis can enable germs and bacteria to enter the skin. Keeping the skin area clean and moisturized can help to reduce the risk of infection.
Dietary changes, supplements, and a reduction in stress can also help to relieve symptoms.