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Medical Author:

Gary W. Cole, MD, FAAD

Gary W. Cole, MD, FAAD

Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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To best understand the causes of pustular psoriasis, one must know the causes of classical plaque-type psoriasis. It is generally agreed that a combination of genetics and environment induce psoriasis, including this pustular subtype. Below is a list of factors that are known to be associated with pustular psoriasis:

• Taking systemic steroids (steroid medications given by mouth or by injection) and then discontinuing them
• Various drugs, including the following
• Salicylates, compounds made from salicylic acid, often used to treat pain and fever
• Iodine, a topical antiseptic
• Lithium or trazodone, antidepressants
• Phenylbutazone or oxyphenbutazone, nonsteroidal anti-inflammatory drugs (NSAIDs)
• Penicillin, an antibiotic
• Hydroxychloroquine, an antimalarial drug
• Calcipotriol, a vitamin-D derivative
• Interferon alfa and recombinant interferon-beta injections, chemotherapeutic agents
• TNF-alfa blocker biologics, including adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade)
• Strong, irritating topical solutions (creams or ointments applied to the skin), including tar, anthralin, steroids under occlusion, and zinc pyrithione in shampoo
• Infections
• Pregnancy
• Sunlight or phototherapy
• Cholestatic jaundice (a yellowish staining of the skin and eyes, caused by bile)
• Hypocalcemia (abnormally low levels of calcium in the blood)

In many people, the trigger is never identified.

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