Pustular Psoriasis Treatment Options

Reviewed by: HU Medical Review Board | Last reviewed: February 2024

Pustular psoriasis is a rare type of psoriasis. It is characterized by small, painful, pus-filled bumps on the skin called pustules. Based on where it develops and how severe it is, there are different types of pustular psoriasis. Treatment for the condition depends on the type and severity.1,2

Pustular psoriasis is not the same as plaque psoriasis, but the conditions are related. About 3 percent of people with psoriasis develop pustular psoriasis. Some people develop pustular psoriasis on its own.1-3

What causes pustular psoriasis?

Pustular psoriasis is caused by an overactive immune response. This response causes inflammation that creates skin irritation and pustules.1,2

Types of pustular psoriasis

Pustular psoriasis may be limited to small areas like the hands or feet. This is called palmoplantar pustular psoriasis (PPP) or localized pustular psoriasis.1-3

When it affects larger areas of the body, the condition is called generalized pustular psoriasis (GPP). The pustules can appear suddenly, and they may come with a fever or chills. These episodes are called flares.1-3

When these pustules appear during pregnancy the condition is called impetigo herpetiformis or pustular psoriasis of pregnancy.1-3

Another, less common, type of pustular psoriasis is Acrodermatitis continua of Hallopeau (ACH). In ACH, pustules develop only on the fingertips or toes.1-3

Symptoms of pustular psoriasis

Your exact symptoms will depend on the type of pustular psoriasis you have. Possible symptoms include:1,2

  • Itchy skin
  • Pus-filled bumps on the skin
  • Red, irritated skin
  • Fever, chills, or weakness during a flare
  • Sore or painful skin

Diagnosing pustular psoriasis

Your doctor will diagnose pustular psoriasis based on your symptoms and medical history. They may examine the skin all over your body to see how widespread the pustules are. This can also help them rule out other conditions. Once you are diagnosed, they may use other tests to make sure you have no complications.2,4

Treatment for pustular psoriasis

Treatment depends on the type of pustular psoriasis you have. In general, the goal of treatment is to clear up pustules and manage symptoms.4,5

Treatment for generalized pustular psoriasis

GPP can be life-threatening and typically needs more advanced treatment than other types of pustular psoriasis. You may need to take medicine to get a flare under control. Medicines for GPP may include:4,5

  • An oral retinoid such as acitretin.
  • A biologic drug such as infliximab (Remicade®) or Spesolimab (Spevigo®). Spesolimab is the only medicine approved in the United States specifically for GPP flares.

These drugs can have severe side effects, such as increased risk of infections, allergic reactions, and increased risk of birth defects in unborn babies. Because of these side effects, some people may need to take a less aggressive drug. Other drugs that may be used to treat GPP include:4,5

  • Apremilast
  • Methotrexate
  • Cyclosporine

Your doctor may prescribe two medicines together to better control the flare.4,5

Because of the risk for complications during pregnancy, treatment for impetigo herpetiformis is different from treatment for GPP. Typically, treatment starts with medicine applied to the skin, like a steroid or vitamin D cream. If this does not work, your doctor may prescribe a steroid medicine or light therapy (phototherapy). As a last resort, you may have to use biologic or retinoid drugs.4,5

Treatment for palmoplantar pustular psoriasis

Possible treatments for mild cases of PPP include:4,5

  • Steroid creams for the skin
  • Synthetic vitamin D cream for the skin
  • Salicylic acid applied to the skin
  • Phototherapy

For more serious cases, your doctor may prescribe an oral retinoid or biologic.4,5

Treatment for Acrodermatitis continua of Hallopeau

Treatment for ACH can be similar to that for other types of pustular psoriasis. Your doctor may recommend a steroid or synthetic vitamin D cream. You also may receive a special type of phototherapy called psoralen plus ultraviolet A (PUVA). With PUVA, you take a medicine called psoralen before the treatment.4,5

If the pustules continue to spread away from your fingertips or toes, you may need stronger treatments.4,5

Before beginning treatment for pustular psoriasis, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

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Treatment results and side effects can vary from person to person. This treatment information is not meant to replace professional medical advice. Talk to your doctor about what to expect before starting and while taking any treatment.

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