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What Is Pustular Psoriasis?

Reviewed by: HU Medical Review Board | Last reviewed: July 2016.

Pustular psoriasis is a rare and severe form of the disease. The symptoms of pustular psoriasis are different than those of plaque psoriasis, which is the most common form of psoriasis. People with pustular psoriasis will often need strong types of treatment to reduce the symptoms.

What are the symptoms of pustular psoriasis?

A flare-up of pustular psoriasis happens when symptoms called “pustules” develop on a person’s skin. First, areas of the person’s skin become red, dry, and sore to the touch. Shortly afterward, pustules start to appear on the reddened areas1. Pustules look like small white blisters that are filled with pus. This pus is a clear liquid filled with white blood cells. After a day or so, the smaller pustules usually combine together to form larger areas of pus. These areas of pus eventually dry out and peel off. This leaves behind a smooth area of skin where pustules may appear again.

Areas of pustules can occur anywhere on a person’s body. However, they frequently occur on the palms of the hand or the soles of the feet.

Despite their appearance, pustules are not contagious and cannot be passed from person to person2. They do not contain any type of infection. However, pustular psoriasis must be treated because it can cause some serious complications that affect the entire body3, including:

  • Headache
  • Fever and/or chills
  • Increased heart rate
  • Weakness
  • Nausea and/or loss of appetite

What are the different types of pustular psoriasis?

Most people with the condition will have periods of “remission” between flare-ups of symptoms. During these times, the pustules disappear and for many people, the skin returns to normal before a “relapse,” which is when another flare-up happens2.

There are two main types of pustular psoriasis. The first type is called “subacute generalized pustular psoriasis.” People with this type do tend to have relapses, but they tend to experience fewer of the serious complications (listed above)3. This type is more common among children.

The second type is more serious, and it is called “generalized pustular psoriasis (von Zumbusch variant).” The flare-ups tend to be very severe, more frequent, and more likely to cause dangerous complications4. People with this type of the disease may need to be treated in the hospital. If a woman has generalized pustular psoriasis while she is pregnant, it is sometimes called “impetigo herpetiformis.” For the safety of the mother and child, it is important to receive treatment as soon as possible5.

How common is pustular psoriasis?

Pustular psoriasis is very uncommon in the United States: less than 2% of people with psoriasis have this form of the disease. It tends to occur more often among older people, with an average age of around 50 for a person’s first flare up2. Research suggests that around 1 in 10 people who develop pustular psoriasis have had symptoms of plaque psoriasis in the past4. In the United States, pustular psoriasis tends to affect men and women at equal rates.

What can trigger pustular psoriasis?

Researchers have identified several possible triggers for flare-ups of pustular psoriasis, including1:

  • Certain types of oral and topical medications
  • Stopping corticosteroid treatment too quickly
  • Staph or strep (bacterial) infections
  • Pregnancy
  • Stress
  • Sunlight or phototherapy

Certain types of oral medications that can cause flare-ups include2:

  • Aspirin
  • Lithium
  • Iodine
  • Some beta blockers
  • Indomethacin
  • Calcipotriol

Strong topical medicines applied to the skin can also cause pustular psoriasis in some people. Examples of these medicines are coal tar, anthralin, and medicated shampoos.

Corticosteroids are very strong medicines that are used to treat inflammation, which is an underlying cause of psoriasis. Pustular psoriasis can be triggered in a person who has been taking corticosteroids but stops treatment too quickly, without gradually lowering the dose under the supervision of a health care provider6.

How is pustular psoriasis treated?

Pustular psoriasis is a serious condition that requires strong forms of treatment. The exact course of treatment chosen by a healthcare provider will depend upon how severe that person’s disease is, and how much of the person’s skin is affected3. Most patients will receive a combination of treatments, which might include:

  • Oral retinoid medicine, such as acitretin or isotretinoin
  • Immunosuppressant medicine, such as methotrexate or cyclosporine
  • Biologic therapy, such as infliximab or adalimumab
  • Corticosteroids
  • Antibiotics
  • Phototherapy

In addition to those treatments, many people find some relief from discomfort through use of a compress with emollients and/or baths with saline or oatmeal.

Because pustular psoriasis can be so severe, some patients may need to have treatment in the hospital for a time in order to have proper specialist care4.

Can pustular psoriasis be cured?

Pustular psoriasis cannot be cured, and people with the disease tend to experience multiple flare-ups over time. However, identifying and avoiding your personal triggers can be helpful in preventing some flare-ups3. Being careful to take all prescribed medicines regularly and as instructed can also help to reduce the frequency of flare-ups.

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