Pustular Psoriasis Treatment

Medical Treatment

People with the generalized form of pustular psoriasis are often admitted to the hospital to make sure they have adequate fluid intake and bed rest and don’t lose too much heat or have too much strain on the heart. Bland compresses are applied to the skin, and saline (saltwater) solutions and oatmeal baths help to soothe and heal affected areas. In children with pustular psoriasis, this treatment is often all that’s needed.

There are 3 basic types of treatments for psoriasis: (1) topical therapy (drugs used on the skin), (2) phototherapy (light therapy), and (3) systemic therapy (drugs taken into the body). All of these treatments may be used alone or in combination.

• Topical therapy: Medications applied directly to the skin are the first course of treatment options. The main topical treatments are corticosteroids, vitamin D-3 derivatives, coal tar, anthralin, or retinoids. There isn't one topical drug that is best for all people with psoriasis. Because each drug has specific adverse effects, it is common to rotate them. Sometimes drugs are combined with other drugs to make a preparation that is more helpful than an individual topical medication. For example, keratolytics (substances used to break down scales or excess skin cells) are often added to these preparations. Some drugs are incompatible with the active ingredients of these preparations. For example, salicylic acid (a component of aspirin) inactivates calcipotriene (form of vitamin D-3). On the other hand, drugs such as anthralin (tree bark extract) may require addition of salicylic acid to work effectively.
  
  
• Phototherapy (light therapy): The ultraviolet (UV) light from the sun slows the production of skin cells and reduces inflammation. Sunlight helps reduce psoriasis symptoms in some people. If psoriasis is widespread, as defined by more patches than can easily be counted, then artificial light therapy may be used. Resistance to topical treatment is another indication for light therapy. Pustular psoriasis may be accompanied by erythroderma (or generalized skin redness and peeling), in which case some people are simply too red to be treated with UV light, making other forms of therapy necessary. Proper facilities are also required for the two main forms of light therapy. The medical light source in a physician's office is not the same as the light sources generally found in tanning salons.  
  
  
  • Oral psoralen (a prescription medication) plus ultraviolet-A (UV-A) light (PUVA): PUVA is a therapy that combines a psoralen drug with UV-A light therapy. Psoralen drugs make the skin more sensitive to light and the sun. Methoxsalen is a psoralen that is taken by mouth several hours before UV-A light therapy. UV-A is light with wavelengths of 320-400 nm. More than 85% of people with regular psoriasis report relief of disease symptoms with 20-30 treatments. Therapy is usually given 2-3 times per week on an outpatient basis, with maintenance treatments every 2-4 weeks until remission. Adverse effects of PUVA therapy include nausea, itching, and burning. Long-term complications include increased risks of sensitivity to the sun, sunburn, skin cancer, and cataracts. People with pustular psoriasis are usually too toxic and have too red and tender of skin during a flare-up to tolerate PUVA. However, some studies have shown that PUVA could be safe and effective in controlling flare-ups in both children and adults. Usually, PUVA is started after your condition has been stabilized with acitretin, a prescription oral retinoid drug. One regimen is 0.2-0.5 mg/kg of acitretin for 7 days, then PUVA 3 times per week. As the pustular psoriasis clears, the acitretin can be withdrawn. The PUVA can be continued for 2 months or longer as needed.
    
    
  • Ultraviolet-B (UV-B) and narrow-band UV-B light: UV-B light is also used to treat psoriasis. UV-B is light with wavelengths of 290-320 nanometers (nm). (The visible light range is 400-700 nm.) UV-B therapy is usually combined with one or more topical treatments. The major drawbacks of this therapy are the time commitment required for treatments and the accessibility of UV-B equipment.
  
  
• Systemic agents: For generalized pustular psoriasis, systemic agents such as retinoids may be required from the beginning of treatment. This may be followed by PUVA treatment. For milder and chronic forms of pustular psoriasis, topical treatment or light treatment may be tried first. People whose disease is disabling for physical, psychological, social, or economic reasons may also be considered for systemic treatment.