Psoriasis is a skin condition that causes red, scaly skin patches. It can occur anywhere on the body, but it’s often found around the knees and elbows. You can get psoriasis at any age, but the average age of adults who get it is 15–35 years old. It’s rare for children under the age of 10 to get this condition. Psoriasis is not contagious, and it can actually appear in different forms. One of these forms is pustular psoriasis, which produces white, noninfectious pus-filled blisters (pustules).
Pustular psoriasis can happen in conjunction with other forms of psoriasis, such as plaque psoriasis. It can break out in single areas, such as the hands and feet, or all over your body. But 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 form. Eventually, these blisters turn brown and crusty. After they peel off, skin can appear shiny or scaly.
Pustular psoriasis is not a typical skin rash. Visit a doctor if you notice unusual skin changes or if you have a rash, blister, or open sore that does not improve or worsens.
To diagnose pustular psoriasis, your doctor may perform a complete blood count to check for signs of abnormalities with your white blood cells and signs of elevated inflammation. Your blood work may show reduced lymphocytes, a type of white blood cell, if you have pustular psoriasis. Sometimes, doctors will remove and examine a sample of the pustule to diagnose the condition. Learn everything you need to know about psoriasis.
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. Von Zumbusch can recur in cycles, returning every few days or weeks. Von Zumbusch is rare in children, but when it does occur the outcome is better than when it appears in adults. In children, the condition often improves without treatment.
- severe itching
- rapid pulse rate
- muscle weakness
Immediate medical care is necessary for this condition. Over time von Zumbusch 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.
Treatment: Treatment may include antibiotics, rehydration, and topical creams. If these don’t work, your doctor may prescribe an oral steroid to relieve symptoms. Sudden withdrawal of oral steroids can cause reoccurrence of von Zumbusch psoriasis. You’ll have to slowly wean yourself off this medication with a doctor’s supervision. Talk to your doctor about the risks of oral steroids to fully understand the effects.
Palmoplantar pustulosis (PPP) is a type of pustular psoriasis that forms on the palms of your hands (usually at the base of your thumb), as well as on the soles of your feet and the sides of your heels. These pustules begin on top of red patches of skin and later 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.
Treatment: To treat PPP, you may need a combination of different treatments, such as a topical treatment, ultraviolet radiation treatment, or an immune system suppressant like methotrexate. Talk to your doctor about your treatment options for PPP.
Acropustulosis is a rare form of pustular psoriasis. It’s clearly identifiable by painful 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 severe enough to cause toenail deformities and physical changes to the bone and finger.
Treatment: There is little evidence of what effectively treats acropustulosis. This condition is very rare and likely requires a combination of topical ointments and medications.
Pustular psoriasis can be triggered by a variety of factors, including:
- emotional stress
- skin injury
- exposure to certain metals or chemicals
- overexposure to UV light
Certain drugs may also cause pustular psoriasis. These drugs include internal medications, systemic steroids, and topical medications. It can also be caused by rapid withdrawal from strong topical steroids or systemic medications.
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.
Your doctor may prescribe medications such as:
- oral psoralen plus ultraviolet A light
- TNF-alpha blockers such as infliximab (Remicade), adalimumab (Humira), and etanercept (Enbrel)
- interleukin-12/23 inhibitors such as ustekinumab (Stelara)
TNF-alpha blockers and interleukin-12/23 inhibitors belong to a group of powerful drugs known as biologics.
The appearance of your skin may cause feelings of anxiety, but the outlook for pustular psoriasis is good with treatment. Treatment can improve and eventually clear the skin, depending on the type of pustular psoriasis, frequency of flare-ups, reaction to treatment, and your overall health.
Children who don’t develop secondary infection have a good prognosis. In older adults, especially those with von Zumbusch pustular psoriasis, aggressive treatment is necessary to prevent serious complications. Treatment will also help with reducing your risk of a flare-up.
It's important to take steps to avoid triggers. These steps include:
- avoiding environmental factors
- quitting smoking
- limiting sun exposure
- minimizing alcohol use
- taking steps to reduce stress such as deep breathing exercises, getting sleep
- exercising regularly
You may also want to find a counseling or a support group. Support groups can provide advice or insights into treatments or new research. Talking to someone about how your condition makes you feel may help with any feelings of anxiety or stress. Visit the National Psoriasis Foundation to look for ways to get involved or for more information.