Psoriasis Australia

Pustular Psoriasis

Pustular psoriasis is a rare but severe form of psoriasis that is characterized by the presence of white pustules (blisters of non-infectious pus) surrounded by red or inflamed skin.

What is Pustular Psoriasis?

Pustular psoriasis is a rare but severe form of psoriasis that is characterized by the presence of white pustules (blisters of non-infectious pus) surrounded by red or inflamed skin. These pustules can appear on different areas of the body, including the hands, feet, or as generalized pustular psoriasis (GPP), which affects large areas of the body. Unlike plaque psoriasis, pustular psoriasis involves widespread inflammation and can present serious systemic symptoms such as fever, chills, and fatigue.

Types of Pustular Psoriasis

Pustular psoriasis is divided into subtypes based on its presentation and the areas affected:

  1. Generalized Pustular Psoriasis (GPP)
    GPP is a severe and life-threatening form of the disease where pustules cover large areas of the body. Symptoms often include fever, fatigue, and a rapid spread of pustules, followed by peeling of the skin. GPP requires immediate medical attention.

  2. Palmoplantar Pustulosis (PPP)
    This type of pustular psoriasis affects the palms of the hands and soles of the feet, causing painful pustules. It is more localized compared to GPP but can still be disabling, especially due to the discomfort of walking or using the hands.

Causes and Triggers

The exact cause of pustular psoriasis, like other forms of psoriasis, is not fully understood. However, genetic factors and immune system dysfunction play significant roles. Individuals with certain genetic mutations, such as in the IL36RN gene, are more likely to develop GPP.

Common triggers of pustular psoriasis include:

  • Infection: Bacterial or viral infections can trigger flare-ups.
  • Medications: Sudden withdrawal of corticosteroids or certain systemic medications can cause pustular psoriasis to flare.
  • Pregnancy: Known as impetigo herpetiformis, pustular psoriasis can occur during pregnancy.
  • Stress: Emotional or physical stress can worsen symptoms.
  • Environmental Factors: Exposure to certain chemicals or extreme weather conditions can exacerbate symptoms.

Symptoms of Pustular Psoriasis

  • Pustules: White blisters of non-infectious pus, often surrounded by red skin.
  • Inflammation: The affected skin is inflamed, red, and tender.
  • Systemic Symptoms: GPP is often accompanied by fever, fatigue, chills, and malaise.
  • Peeling Skin: Following the pustular phase, the skin may peel off in sheets.
  • Pain: In cases like PPP, pustules can cause significant pain, making it difficult to walk or use the hands.

Diagnosing Pustular Psoriasis

Pustular psoriasis is diagnosed through a clinical examination of the skin. A dermatologist may order blood tests to check for elevated white blood cells or inflammatory markers. In some cases, a skin biopsy may be performed to rule out other conditions that cause pustules, such as infections.

Treatment Options

Management of pustular psoriasis often requires a combination of treatments, especially in severe cases like GPP. Treatments may vary depending on the severity and subtype, but common approaches include:

  1. Topical Treatments

    • Corticosteroids: Potent topical corticosteroids can help reduce inflammation and pustules in localized forms like PPP.
    • Vitamin D Analogues: Calcipotriol (Daivonex) may be used alongside corticosteroids to reduce scaling and inflammation.

  2. Systemic Therapies

    • Acitretin: An oral retinoid used to reduce pustules and scaling.
    • Methotrexate: A systemic immunosuppressant that can control severe cases of GPP.
    • Cyclosporine: Another immunosuppressant used in cases resistant to other treatments.
    • Biologic Therapies: Drugs which target specific components of the immune system, may be prescribed for severe or treatment-resistant cases.

  3. Phototherapy Phototherapy with narrowband ultraviolet B (NB-UVB) or psoralen combined with ultraviolet A (PUVA) is less commonly used but may be beneficial for some patients with milder forms of pustular psoriasis.

  4. Hospitalization For severe GPP, hospitalization may be necessary to manage systemic symptoms and monitor treatment. Intravenous treatments, such as infliximab, or systemic immunosuppressants may be administered in such cases.

Lifestyle and Management Tips

  • Moisturizing: Regularly applying emollients can help reduce scaling and keep the skin hydrated.
  • Stress Management: Since stress can trigger flare-ups, practicing relaxation techniques, meditation, or yoga may be beneficial.
  • Avoid Triggers: Identifying and avoiding personal triggers, such as infections, certain medications, or harsh chemicals, can help manage the condition.
  • Quit Smoking: Smoking is associated with a higher risk of developing palmoplantar pustulosis, and quitting can reduce flare-ups.

Summary

Pustular psoriasis is a rare and challenging condition that requires a combination of medical treatments and lifestyle adjustments. Early diagnosis and appropriate treatment are key to managing symptoms and preventing complications. If you suspect you have pustular psoriasis or experience a flare-up, consult with a dermatologist promptly for assessment and treatment.