Symptoms and Signs of Pustular Psoriasis

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 11/4/2021

Doctor's Notes on Pustular Psoriasis

Pustular psoriasis is a rare form of psoriasis that appears as clearly defined, raised bumps filled with pus (a white, thick fluid composed of white blood cells). The skin under and around the bumps is red. Pustular psoriasis is classified into one of several types, depending on symptoms. Symptoms may be sudden and severe (acute), long term (chronic), or in between (subacute). Widespread pustular psoriasis (von Zumbusch type) affects large areas of skin and can cause fever.

In the generalized form of pustular psoriasis, symptoms include

  • fiery red and tender skin,
  • headache,
  • fever,
  • chills,
  • joint pain,
  • a feeling of general discomfort or uneasiness,
  • decreased appetite, and
  • nausea, along with clusters of pustules.

Pustules tend to appear on the anal and genital areas and the skin folds in the skin. In 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 causing discomfort and exhaustion. Once the pustules improve, most other symptoms usually disappear. 

What Is the Treatment for Pustular Psoriasis?

Treatment for generalized pustular psoriasis (GPP) in adults includes:

  • Oral retinoids
  • Infliximab: a biologic, which can decrease inflammation (and bumps) quickly
    • Because patients often respond rapidly, some experts believe this may be the first choice when GPP is severe
  • Synthetic vitamin D
  • Phototherapy (light treatments)
  • Topical corticosteroids
  • Salicylic acid

Because the above are potent treatments, they may not be suitable for some patients. Other medications may be used to get the psoriasis under control. Possible psoriasis medications that may be prescribed include:

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.