Pustular Psoriasis
Symptoms of Pustular Psoriasis
Pustular psoriasis is a rash, characterized by pustules, which are blister-like lesions of non-infectious fluid, and intense scaling. Individuals with pustular psoriasis are often among the most seriously ill and may have to be hospitalized. This type of psoriasis rash usually appears as a large red area covered with yellow-green pustules. They tend to be one to two millimeters in diameter and may be very tender. The yellow color is caused by masses of white blood cells (polymorph leucocytes), which flood into any part of the skin that is damaged or infected, in order to fight infection and aid recovery. After seven to 10 days, the pustules become dispersed and a brown scale appears. This scale will start to shed as new pustules develop in other areas, often in a continuous cycle. The most common type of pustular psoriasis affects the palms and soles of the feet. It isn't normally itchy however it can be sore or uncomfortable to use either your hands or feet, for example if you are writing or walking. The changes in your skin that you observe prior to, during, and following an episode of pustular psoriasis may be quite similar to or even mistaken for other forms of psoriasis. Psoriasis symptoms include patches of raised skin with areas of scaling.
Pustular psoriasis can be classified depending on the severity of the symptoms:
- Acute in which the symptoms appear suddenly and are severe in appearance.
- Chronic, which are, classified as long-term episodes, which re-occur frequently.
- Sub-acute which a classification in-between sudden and severe episodes and long-term re-occurring episodes.
Pustular psoriasis is further divided in subsets defining specific symptoms and conditions in which it occurs:
Generalized pustular psoriasis is spread over wide areas of the body, is also called von Zumbusch pustular psoriasis, named after the physician who first described it in the early 1900s. Generalized pustular psoriasis is identified with acute symptoms, fever, and toxicity. Called generalized due to the general reddening and inflammation of the skin with sheets of small pustules merging into larger sheets mark generalized pustular psoriasis. The condition begins with the development of reddened, painful and tender skin over much of the body, followed in a matter of hours by pustules. Over the next one to two days, the pustules will dry, peel, and leave the skin with a glazed, smooth appearance. Episodes often occur in waves that last for several days or weeks. Von Zumbusch pustular psoriasis is associated with fever, chills, severe itching, dehydration, rapid pulse rate, exhaustion, anemia, and weight loss and muscle weakness. Treatment for von Zumbusch pustular psoriasis often requires hospitalization for dehydration and initiation of topical and systemic treatments, which typically include antibiotics. Von Zumbusch pustular psoriasis can be triggered by an infection; sudden withdrawal of topical or systemic steroids; pregnancy; and drugs such as lithium, propranolol and other high blood pressure drugs; iodides and indomethacin.
In Palmoplantar pustulosis, the pustules are more localized, occurring primarily on the palms of the hands and soles of the feet. Palmoplantar pustulosis is characterized by multiple pustules the size of pencil erasers in fleshy areas of the hands and feet, such as the base of the thumb and the sides of the heels. The pustules appear in a studded pattern throughout reddened plaques of skin, then turn brown, peel and become crusted. The episodes occur in cycles, with flares of pustules followed by periods of low activity. Research has suggested that an abnormal response to nicotine can trigger flares in individuals with palmoplantar pustulosis.
Acropustulosis also called Acrodermatitis Continua of Hallopeau. This is a less common form of pustular psoriasis is characterized by skin lesions on the ends of the fingers and sometimes the toes. The eruption occasionally starts after an injury to the skin or infection. Often the lesions are painful and disabling, resulting in a deformity of the nails. Bone changes can occur in severe cases.
Annular pustular psoriasis is a ring-shaped form of pustular psoriasis. It is usually sub acute or chronic, and people with this type do not usually have symptoms aside from the skin symptoms. Annular pustular psoriasis tends to have a ring-like appearance where the outer margin is red with lighter or normal looking skin inside the circle. Annular pustular psoriasis is a rare variation of pustular psoriasis which has a tendency to spread and form enlarged rings. It is the most common form of pustular psoriasis in children but can occur in adults also.
Infantile pustular psoriasis is a form of pustular psoriasis that tends to occur during infancy. The skin under and around the pustules is red and has a tendency to occur in repeated waves with frequent spontaneous remissions. The symptoms of Infantile pustular psoriasis include; raised pus-filled skin bumps, skin redness around pustules, stinging, burning sensations, itching and peeling skin.
Treatment of Pustular Psoriasis
Pustular psoriasis is a serious and potentially life-threatening illness that can severely disrupt the skin’s function. Individuals with pustular psoriasis are often among the most seriously ill and may need to be hospitalized.
