Pustular psoriasis is an uncommon type of psoriasis that causes small, pus-filled blisters. Very rarely, these pustules may appear on your face.

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Psoriasis is a noncontagious autoimmune disease that affects about 2% to 3% of the global population. Pustular psoriasis, on the other hand, is far less common: Only about 1% of people with a psoriasis diagnosis have pustular psoriasis. But many people have both pustular psoriasis and another type of psoriasis.

Pustular psoriasis is marked by small, whiteish, pus-filled blisters, or pustules. You’ll most often notice these pustules on the soles of your feet and the palms of your hands. They may also show up elsewhere on your body or on your face, but this doesn’t happen often.

Here’s what to know about identifying pustular psoriasis on your face and getting treatment.

Pustular psoriasis happens in periods of flares, or outbreaks, and remissions.

At the beginning of a flare, you’ll usually notice your skin feels tender and changes color. For instance, it may appear reddish, violet, or dark purple, depending on your skin tone.

In just a few hours, you may start to notice pustules beginning to pop up. These pustules, which can feel very painful, contain white or yellowish pus and may burst open. They’ll eventually darken in color and then crust over. The pustules then peel off, leaving your skin underneath scaly or shiny.

Generally speaking, pustular psoriasis tends to show up on your hands and feet. You may notice pustules on other parts of your body, but they only rarely show up on your face. If you do develop pustules on your face, you’ll most likely have them on other parts of your body too.

The pustules may, in some cases, resemble an acne breakout. It’s also possible to confuse the pustules with symptoms of another skin condition or infection, such as eczema or herpes.

Von Zumbusch pustular psoriasis

This rare type of pustular psoriasis, also called generalized pustular psoriasis, can cause pustules over large areas of your body, not just your face. It’s very serious — sometimes fatal — and requires immediate medical care.

Without treatment, you may experience hair and nail loss, bacterial infections, liver damage, or cardiorespiratory failure.

Other signs and symptoms of this condition include:

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Experts have yet to fully determine the cause of pustular psoriasis.

Psoriasis is an autoimmune disease, which means your immune system plays a role. When you have an autoimmune disease such as psoriasis, your body attacks healthy tissue by mistake, which causes your flares.

Factors that may trigger a pustular psoriasis flare include:

  • smoking
  • pregnancy
  • facial skin injuries or infections
  • excess sunlight or ultraviolet (UV) light exposure on your face
  • weather changes, particularly cold, dry, or windy weather
  • certain foods, chemicals, or medications, such as biologics or systemic steroids
  • having another autoimmune disease

Your genes may also increase your chances of developing psoriasis, since the condition seems to run in families.

Pustular psoriasis is more common in adults, though it may sometimes affect children.

Impetigo herpetiformis

This type of pustular psoriasis begins during the last trimester of pregnancy and involves pustules that develop on your inner thighs, groin, under your nails, and inside your mouth.

These pustules will cluster together, join, and spread across your body.

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Pustular psoriasis tends to have a pretty distinct appearance when compared with more common rashes and skin conditions. That said, it’s still fairly rare, especially when it affects your face. So, getting the right diagnosis may sometimes prove challenging.

If you have a discolored rash or blisters that don’t seem to improve over time, or come and go in cycles, a good next step involves connecting with a dermatologist. These doctors specialize in diagnosing and treating conditions that affect your skin, hair, or nails. Some dermatologists may recognize pustular psoriasis on sight.

Dermatologists can use other tests to confirm a suspected diagnosis and rule out other skin conditions. They may recommend:

  • A physical exam and medical history: A dermatologist will want to confirm you don’t have pustules on other parts of your body. A personal and family medical history can help them help pinpoint any factors or triggers that might raise your risk of psoriasis.
  • A complete blood count (CBC): This blood test can reveal signs of inflammation, along with irregularities in your white blood cell levels. A low count of lymphocytes — a type of white blood cell — is one sign of pustular psoriasis.
  • Electrolyte and liver panels: These tests can help a dermatologist determine whether you have low blood levels of calcium (hypocalcemia) and excess liver enzymes.
  • A punch biopsy or culture of the pustules: Taking a sample of one of your pustules can help a dermatologist rule out infections and other skin conditions.
  • A pregnancy test: If pregnancy is a possibility for you, a dermatologist will recommend a pregnancy test. This can help them find a safe and effective treatment.

A dermatologist can also offer more guidance with identifying triggers to help minimize future flares.

If you have pustular psoriasis on your face, medical treatments may include:

  • Topical medications: A care team will likely prescribe a topical cream or ointment as the first mode of treatment. These medications don’t just help relieve inflammation and irritation. They may also help lower your risk of flares.
  • UV light therapy: Therapy with either artificial or natural UV light may also help relieve your psoriasis symptoms. A dermatologist may also suggest psoralen and UVA (PUVA) therapy, a treatment that combines psoralens with UV light. You’ll take an oral or topical psoralen drug before the UV treatment to increase your skin’s sensitivity to light.
  • Oral medications or injections: A doctor may prescribe other medications such as the retinoid acitretin (Soriatane), the immunosuppressants cyclosporine or methotrexate, or biologics.

Learn more about treatment options for psoriasis.

At-home remedies may include:

Certain lifestyle changes may also help reduce your risk of flares. It may help to:

Find more home remedies for psoriasis.

Pustular psoriasis can potentially cause pustules on your face, but this is very rare. More often, you’ll notice pustules on other areas of your body, such as your hands and feet.

It’s always a good idea to check in with a doctor, or other healthcare professional, or a dermatologist if you have any persistent sores or rashes on your face. They can give you a thorough diagnosis and recommend the right treatment.

If you live with psoriasis, you can minimize your chances of a flare by avoiding your triggers and keeping your skin hydrated.