Pustular Psoriasis

Definition

The pustules rupture easily and can become infected. Pustular Psoriasis is a disease in which blisters of non-infectious pus appear on the skin, and may affect large or small areas of the body. It is characterized by the development of pustules in the flexural areas -the backs of the knees, the insides of the elbows, the armpits and the groin. If the patient gets dehydrated, then this condition can be fatal. Pustules usually appear on the hands and feet. It can limit to one part of the body or can be widespread. Mostly, it appears between the ages of 20 and 60.

The disease usually becomes much less active for a while after peeling. It can be life-threatening especially in the elderly .Generalized pustular psoriasis is also known as Von Zumbusch pustular psoriasis.

Causes of Pustular Psoriasis

The possible causes of pustular psoriasis are as:-

• Strong, irritating topicals, including tar, anthralin and zinc pyrithione in shampoo may affect the skin and thus causing pustular psoriasis.
• A person suffering from cholestatic jaundice, are more prone to get affected by pustular psoriasis.
• Hypocalcemia may trigger pustular psoriasis.
• Excessive alcohol intake is associated with deterioration and lead to in the production of pustular psoriasis.
• Infection may trigger the formation of pustular psoriasis.
• A history of chronic plaque psoriasis may also lead to pustular psoriasis.
• A positive family history in first degree relatives is seen in approximately 30 per cent of patients with pustular psoriasis.
• The environmental factors, that may aggravate psoriasis include infections, psychological stress, alcohol, drugs, sunlight and trauma.
• Lithium and antimalarials are well known for exacerbating or inducing pustular psoriasis.
• Beta blockers, NSAIDs and ACE inhibitors can also be associated with flares of pustular psoriasis.
• Sunlight or photo therapy are also responsible in the production of pustular psoriasis.

Symptoms of Pustular Psoriasis

The common symptoms of pustular psoriasis are as:-

• Skin can split and bleed in the affected areas, especially when over joints or on the palms or feet
• The scales are dry, thin, and silvery-white. The thickness of the scales may vary. When the scale is removed, the skin underneath looks smooth, red, and glossy. 
• Nail changes are commonly observed in those with pustular psoriasis. The nails may have small indentations, ridges, or pits in them. The nails can loose color or separate from the nail bed.
• Itching, may occur especially during sudden flare-ups or when the psoriasis patches are in body folds, such as under the breasts or the buttocks.
• Thickening and reddening of patches can be seen . Patches generally occur on the elbows, knees, scalp and lower back.
• The plaque areas vary in size and may range from a few to many at any given time on the skin.  areas and form a large affected area. 

Treatments of Pustular Psoriasis

The effective treatments of pustular psoriasis includes:-

• Steroid creams : This is the most widely used treatment, and can reduce inflammation and plaques.
• UVB radiation: It is effective for both chronic pustular and guttate psoriasis.
• Methotrexate: It is particularly useful for acute generalised pustular psoriasis, erythrodermic psoriasis, psoriatic arthritis.
• Ciclosporin A: It is an immunosuppressant that is very effective in the treatment of pustular psoriasis.
• Acitretin is the most commonly prescribed retinoid for the treatment of pustular psoriasis.
• Hydroxyurea: It is an effective treatment for patients with chronic plaque psoriasis.
• Vitamin A derivatives, in tablet form are very effective in the treatment of pustular psoriasis.
• Tar compounds: Which are especially useful for psoriasis of the scalp.
• Psoralen and ultraviolet: A light treatment involves a medicine which sensitizes the skin to sunlight with a controlled dose of ultraviolet light.