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Sep 30, 2021
3 min read

Pustular psoriasis: what is it, symptoms, types, and treatment

Pustular psoriasis is a painful subtype of psoriasis that may affect the palms of the hands and soles of the feet, in addition to other areas of the body. Red, inflamed lesions and pus-filled blisters are the most prominent symptoms. Treatment may include topical and oral medications in order to control future flare-ups.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Those who live with pustular psoriasis—a subtype of psoriasis—know that aside from the physical discomfort and pain it can cause, it can take a toll on the psyche due to it being such a visible medical condition. Here is what you need to know about pustular psoriasis, including some of the red flags that differentiate it from standard plaque psoriasis.

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What is pustular psoriasis?

Pustular psoriasis is a chronic inflammatory skin disease and form of psoriasis (Crowley, 2021). The affected skin areas of the body become red and painful as it develops sudden pus-filled blisters (often referred to as pustules). Although it usually presents in localized areas, it’s possible for some people to have it more widespread, like on the arms and legs (Crowley, 2021).

Symptoms of pustular psoriasis

Pustular psoriasis symptoms include (Shah, 2021; Benjegerdes, 2016):

  • Red, irritated, or scaly skin lesions.
  • Spontaneous pus-filled blisters on the palms or soles of the feet
  • Fever, chills, or nausea as systemic symptoms that affect the immune system which may arise from the primary symptoms
  • Widespread inflammation (for generalized pustular psoriasis)

Types of pustular psoriasis

Just like pustular psoriasis is a subtype of psoriasis, there are subtypes of pustular psoriasis. Much of these subtypes are classified by where the blisters or lesions are located and how they appear. In general, the lesions and blisters are sensitive to touch and may lead to pustular eruption. The subtypes include (Shah, 2021):

  • Palmoplantar pustular psoriasis (also referred to as PPP): Those with PPP often have pustules on their palms and the soles of their feet.
  • von Zumbusch (also known as acute generalized pustular psoriasis, or GPP): GPP affects large areas of the body and may involve symptoms like fever, chills, and nausea. Acute GPP can also lead to life-threatening complications like sepsis.
  • Impetigo herpetiformis: This is an acute form of GPP that can occur during pregnancy. 
  • Annular: Those with annular pustular psoriasis often have scaly, ring-like lesions that have blisters along the edge of the lesion.
  • Exanthematous pustulosis: This subtype involves pus-filled blisters that don’t typically present with symptoms like fever, chills, or nausea. They pop up spontaneously and resolve somewhat quickly.
  • Acrodermatitis continua of Hallopeau: Blisters located on particularly sensitive areas of the body, including fingers, toes, and nail beds, may be symptoms of this subtype of pustular psoriasis.

Diagnosis of pustular psoriasis

Because pustular psoriasis is an inflammatory disease, receiving an exam from a healthcare provider is often the first step to diagnosing the condition. 

By looking at the type of inflammation—where any blisters are located, as well as how painful the blisters may be—a healthcare provider will be able to distinguish pustular psoriasis from other forms of psoriasis (Crowley, 2021).

In some cases, they may also take a skin biopsy, where a piece of the irritated skin is removed and looked at in a lab to better determine how severe the psoriasis is (Crowley, 2021).

Treatment of pustular psoriasis

There are various treatment options for pustular psoriasis. They include several topical treatments and systemic measures, such as moisturizers or corticosteroids (Mirza, 2020). 

Certain oral medications can also be used. The most prescribed drugs include retinoids like acitretin and immunosuppressive drugs like cyclosporine and methotrexate (Mirza, 2020).

In addition to these treatment options, a healthcare provider may also encourage those with pustular psoriasis—most notably, generalized pustular psoriasis—to stay hydrated and eat a protein-rich diet. And, if there are any underlying infections that may be causing a flare, those will be treated as well (Mirza, 2020).

When to see a doctor

If you feel that you are experiencing an acute episode of generalized pustular psoriasis that is accompanied by fever, chills, and malaise, seek emergency care. Even though it is rare, due to the increased risk of sepsis, acute generalized pustular psoriasis can be life-threatening. It typically begins with red, and tender skin, followed by widespread pus-filled blisters within hours (Hoegler, 2018).

Most of the time, however, experiencing the symptoms of pustular psoriasis, like pus-filled blisters or painful skin irritation on your body, means a trip to your local dermatologist is in order. Not only will they be able to treat the condition early on, but doing so will prevent other complications, such as infection or fever (Crowley, 2021). 

References

  1. Benjegerdes, K., Hyde, K., Kivelevitch, D., Mansouri, B. (2016). Pustular psoriasis: pathophysiology and current treatment perspectives. Psoriasis (Auckl), 6, 131-144 doi: 10.2147/PTT.S98954. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683122/
  2. Crowley, J., Pariser, D., Yamauchi, P. (2021) A brief guide to pustular psoriasis for primary care providers. Postgraduate Medicine, 133(3), 330-344. doi: 10.1080/00325481.2020.1831315. Retrieved from https://www.tandfonline.com/doi/full/10.1080/00325481.2020.1831315
  3. Hoegler, K. M., John, A. M., Handler, M. Z., & Schwartz, R. A. (2018). Generalized pustular psoriasis: a review and update on treatment. Journal of the European Academy of Dermatology and Venereology : JEADV, 32(10), 1645–1651. doi: 10.1111/jdv.14949. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29573491/
  4. Mirza, H. A., Badri, T., Kwan, E. (2020). Generalized Pustular Psoriasis. [Updated Sep 15, 2020]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK493189/
  5. Shah, M., Al Aboud, D. M., Crane, J. S., et al. (2021). Pustular Psoriasis. [Updated Aug 11, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537002/