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Pustular Psoriasis (cont.)

What Are Causes and Risk Factors of Pustular Psoriasis?

To understand pustular psoriasis, one must recognize aspects 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 exacerbate pustular psoriasis:

  • Acutely stopping high-dose systemic steroids
  • Various medications have been associated with exacerbations of psoriasis, including the following:
    • Oral iodides (SSKI)
    • Lithium
    • Phenylbutazone or oxyphenbutazone, nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin
    • Hydroxychloroquine, an antimalarial drug
    • Interferon alfa and recombinant interferon-beta injections
  • Strong, irritating topical solutions (creams or ointments applied to the skin), including tar, anthralin

In most people, a trigger for the disease is never identified.

What Are Pustular Psoriasis Symptoms and Signs?

In the generalized form, the skin is initially fiery red and tender. Someone may have symptoms such as headache, fever, chills, joint pain, a feeling of general discomfort or uneasiness, decreased appetite, and nausea. Within hours, one may see clusters of pustules.

The most common places these pustules appear are the anal and genital areas and the skin folds in the skin. Pustules may appear on the face, but this is unusual. Pustules can appear on the tongue, which may make it difficult to swallow. They can also occur under the nails and cause the nails to come off.

Within a day, the pustules coalesce to form "lakes" of pus that dry and peel off in sheets. The skin underneath is a smooth reddish surface, on which new pustules can appear. These episodes may recur for days to weeks. They can make someone uncomfortable and exhausted.

Once the pustules improve, most of your other symptoms (such as headache and fever) will usually disappear. Occasionally, the skin may remain bright red, and classical plaque type disease may follow.

The ring-shaped type is more common in young children. This type tends to be subacute or chronic, and the symptoms are less severe than in the generalized type. Ring-shaped plaques (elevated areas) appear and are often recurrent. Pustules may appear at the edges of the ring. These areas of skin symptoms appear mostly on the trunk but also on the arms and legs. The edges expand, and the center heals. Other symptoms are either absent or mild.

The juvenile, or infantile, type of pustular psoriasis is usually mild without systemic symptoms. The condition often resolves on its own.

Pustular psoriasis of the palms and soles is usually chronic and is often associated bone or joint inflammation (psoriatic arthritis). The palms or soles are red with white or yellow pustules.

Medically Reviewed by a Doctor on 4/4/2017

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Read What Your Physician is Reading on Medscape

Psoriasis, Pustular »

Pustular psoriasis is an uncommon form of psoriasis consisting of widespread pustules on an erythematous background

Read More on Medscape Reference »


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