Pustular psoriasis

Pustular psoriasis is one of seven types of psoriasis. In its severe form it is also known as von Zumbusch psoriasis.

What is pustular psoriasis?

A non contagious condition, pustular psoriasis is characterized by pus filled spots called pustules, which develop on the skin.

Unlike the more common plaque psoriasis, pustular psoriasis is a rare form and can bring severe complications. In many cases people with pustular psoriasis develop plaque psoriasis first.

What causes pustular psoriasis?

Pustular psoriasis like other types of psoriasis is caused by immune dysfunction. The immune system sends signals to produce skin cells much more rapidly.

The skin cycle usually takes about 28 days. However, with psoriasis the skin cycle lasts only 3 or 4 days.

Newly created immature skin cells are pushed up to the surface of the skin, and white blood cells called T-cells build up underneath the skin.

The build up of T-cells causes skin inflammation. With pustular psoriasis, the white blood cells can also build up on the surface of skin, forming small spots called pustules.

See triggers of pustular psoriasis.

Types of pustular psoriasis

Generalized pustular psoriasis / von Zumbusch psoriasis

In severe cases, pustules can develop all over the body. During this stage the condition is known as generalized pustular psoriasis or von Zumbusch psoriasis.

Palmoplantar psoriasis

Pustular psoriasis is classed as palmo-plantar psoriasis when the pustules only affect the soles of the feet and palms of the hands.

Pustular psoriasis symptoms

Generalized pustular psoriasis symptoms

The pustules have a sudden onset and they can spread quickly over the entire body.

Small, white to yellow colored pustules (spots) can develop anywhere on the skin of the body including the tongue making swallowing difficult. Pustules can form under the nails causing the nails to drop off.

Around the pustules the skin is red, inflamed and may feel hot.

Common areas for pustules include the anus, the genital area and places where there are folds of skin including the buttocks and under the arms.

A person with generalized pustular psoriasis may have a fever and feel ill. A chill often marks the onset of pustular psoriasis.

The physical symptoms of pustular psoriasis can be very distressing for the individual concerned.

Palmo-plantar psoriasis symptoms

Yellow to brown colored pustules (spots) develop on the palms of the hands and the soles of the feet. The skin surrounding the pustules can become inflamed, red and sore. The pustules can repeatedly erupt over weeks, months and even years.

Pustular psoriasis triggers

Flare ups of pustular psoriasis can be triggered by:

  • calcipotriol – a derivative of Vitamin D
  • hypocalcemia – a condition in which there is low levels of calcium in the blood
  • infection
  • jaundice
  • phototherapy
  • pregnancy
  • some medicines – including lithium, trazodone antidepressants, penicillin and the anti malarial drug, hydroxychlorquine
  • sudden withdrawal of current steroid treatments
  • sunlight

Additional triggers for palmo-plantar psoriasis include:

  • smoking tobacco
  • stress

These factors can trigger a dysfunctional response by the immune system which speeds up the skin cycle causing pustular psoriasis symptoms of pustules and skin inflammation.

However, in many cases a trigger can not be identified.

Pustular Psoriasis Treatment

Treatments for pustular psoriasis may include:

  • Phototherapy
  • Systemic Agents
  • Topical treatments
    • anthralin
    • coal tar
    • retinoids
    • vitamin D-3 and derivatives