Psoriasis

What Does Pustular Psoriasis Look Like?

  • What Is Psoriasis?

    Psoriasis is a skin condition that causes red, scaly skin patches. It can occur anywhere on the body, but is most often found around the knees and elbows. A type of psoriasis called pustular psoriasis also causes white, noninfectious pus-filled blisters (pustules).

    Anyone can get psoriasis, but the average age of adult patients is 50. It is rare in children under age 10. Psoriasis is not contagious.

  • Identifying Pustular Psoriasis

    Pustular psoriasis can happen in conjunction with other forms of psoriasis. It can break out in single areas, such as the hands and feet, or all over your body. However, it is rarely seen on the face. It usually begins with an area of skin becoming tender and red. Within a few hours, the telltale large blisters of noninfectious pus begin to form. Eventually, these blisters turn brown and crusty. After they peel off, skin can appear shiny or scaly.

  • Von Zumbusch Pustular Psoriasis

    Von Zumbusch psoriasis (acute generalized pustular psoriasis) begins with painful areas of red skin. Pustules form within hours and dry up in a day or two. Symptoms include severe itching, fever, and dehydration. Immediate medical care is necessary for this condition. Treatment may include antibiotics, rehydration, and topical creams. Von Zumbusch can recur in cycles, returning every few days or weeks. Over time this can cause weight loss and exhaustion. Potential complications include hair and nail loss, secondary bacterial infection, and liver damage. If left untreated, it can lead to cardiorespiratory failure. Von Zumbusch is rare in children.

  • Palmoplantar Pustulosis

    Sometimes pustular psoriasis forms on the palms of your hands (usually at the base of your thumb), as well as the soles of your feet and the sides of your heels. This is called palmoplantar pustulosis (PPP). Pustules begin on top of red patches of skin. Later, the pustules turn brown, peel off, and form a crust. As with Von Zumbusch, PPP can come and go in cycles, leaving the skin with a rough, cracked appearance. Smokers have a higher incidence of PPP than nonsmokers.

  • Acropustulosis

    Acropustulosis is a very rare form of pustular psoriasis. It is clearly identifiable by skin lesions that form on the ends of fingers and toes. When the pustules burst, they leave bright red scaly patches that can ooze. This type of psoriasis is usually the result of an infection or injury to the skin. It can become so severe as to cause toenail deformities and physical changes to the bone and finger. It can be quite painful.

  • Triggers

    Pustular psoriasis can be triggered by a variety of factors, including emotional stress, pregnancy, skin injury, or infection. It can also be the result of exposure to certain metals or chemicals, as well as overexposure to UV light. Certain drugs—including internal medications, systemic steroids, and topical medications—may cause pustular psoriasis. It can also be caused by rapid withdrawal from strong topical steroids or systemic medications.

  • Treatment

    Your treatment will depend on the type of psoriasis you have and how serious it is. Sometimes it takes several approaches or a combination of treatments to find the most effective approach.

    Your doctor will probably prescribe topical skin ointments first because they can soothe your skin and reduce inflammation. Ultraviolet light, both natural and artificial, is used to treat psoriasis. PUVA treatment is a combination of UV light and a medication that makes your skin more sensitive to it.

    Generalized postular psoriasis requires measures to prevent dehydration and infection.

  • Outlook

    Some patients may feel anxious and embarrassed by the appearance of their skin. Counseling or a support group may help reduce stress and anxiety. In many cases, treatment allows patients to live a normal life, especially if they don’t suffer frequent flare-ups.

    Children who don’t develop secondary infection have a good prognosis. In older patients, especially those with Von Zumbusch pustular psoriasis, aggressive treatment is necessary. Serious complications can occur that can become life threatening.

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