What is Pustular Psoriasis? – Types and Treatments

Pustular psoriasis is an immune-mediated skin disease. Pustular psoriasis is characterised by bumps with yellow pus on the skin. The yellow pus-filled bumps are called pustules.

People infected with pustular psoriasis have bumps filled with pus in their hands and feet, which can be painful. Pustular psoriasis can make the skin become thick, scaly and easy to crack. If the pustules spread throughout the body, they can be life-threatening.

Pustular psoriasis can form on the skin, beneath the nail or inside the mouth. After 24–48 hours of formation, the bumps tend to join together and burst open.

Once the bumps and pus dry, the skin becomes red and glazed. The skin becomes raw and tender at this point, making it more painful for the infected person.

There can be the formation of new pustules in the red-glazed skin, and again these pustules can break open. This cycle can continue and spread to other areas.

Pustular psoriasis can occur in genetically susceptible people and can be triggered by certain factors like neutrophil accumulation in the epidermis.

Pustular psoriasis is a rare disease. However, it affects people aged between 40–50 years and infants. Pustular psoriasis affects men and women equally.

Types of pustular psoriasis

Palmoplantar pustulosis (PPP)

Palmoplantar pustulosis is an inflammatory disorder that is rare. A person infected with palmoplantar pustulosis develops small blisters that will be filled with a yellow liquid called pustules.

These pustules generally develop on the hand, palm and soles of feet. The cause of palmoplantar pustulosis is not known clearly, and it primarily affects women aged between 40 and 70 years.

According to National Organisation for Rare Diseases, the causes of palmoplantar pustulosis include:

• Smoking.
• Bacterial infections like chronic or acute tonsillitis and chronic sinusitis.
• Contact allergies like contact dermatitis and some medication.

Palmoplantar pustulosis can also run in families and affect the offspring. There are many treatments available for palmoplantar pustulosis depending on the cause and degree of infection.

The symptoms of palmoplantar pustulosis include scaly plaques with painful fissures, painful itching and a burning sensation on the infected part.

Acropustulosis

Acropustulosis is a rare skin condition commonly seen in infants but can also occur in adults. It causes severe itching accompanied by bumps.

These pustules can be uncomfortable for infants and tend to reduce as the children age. The condition will resolve fully when the infant reaches three years. These bumps will not have any long-lasting effect on the infants.

Initially, these pustules can be seen as red and flat bumps which cause severe itchiness. When the pus formation occurs in the bumps, it becomes yellow or white. Once the bumps break, the pus will be released and spread to other areas.

The pustular psoriasis can occur in groups in infants and are called crops. These crops disappear as the child grows. The pustules last for about 7–14 days, and they disappear. These pustules often tend to reoccur after every two weeks of healing.

Acropustulosis can be commonly seen in hands, palms, ankles, wrists, scalps and soles of the foot. These pustules can cause major discomfort during the time of occurrence, but they will not cause any long-lasting complications.

The cause of acropustulosis is not clearly known, but it can be caused after a scabies infection. However, acropustulosis can occur independent of the scabies infection, and this acropustulosis is not contagious.

Generalized or von Zumbusch

The generalised pustular psoriasis (GPP) was first identified and characterised by von Zumbusch.

Generalised pustular psoriasis is the most severe among the other types and will require immediate medical attention.  If the generalised pustular psoriasis is left untreated, it can be life-threatening and lead to death.

These pustules are characterised by the presence of superficial red pustules with pus. They occur together in numerous bumps and cause severe itching.

People affected with generalised pustular psoriasis have complained that it was accompanied by fever, toxicity and leukocytosis (high white blood cell count).

Symptoms of pustular psoriasis

The symptoms of pustular psoriasis depend on the degree of infection and the person’s immune system. However, some symptoms can be common.

Peeling skin

Peeling of skin is a common symptom of pustular psoriasis. The skin in the infected area becomes scaly and easy to peel.

Fever and shivers

In some instances, pustular psoriasis can cause fever and chills. There can be fluid retention in the affected parts.

Intense itching

Itching is a common characterisation of pustular psoriasis. According to NCBI, about 90% of people complain about itching in pustular psoriasis. Itching can be painful and can be accompanied by a burning sensation.

A rapid pulse

Psoriasis can indicate that a person may have heart disease, and there will be symptoms like a rapid pulse (arrhythmia).

Dehydration and exhaustion

Pustular psoriasis can cause rashes in the body. They might regulate the body temperature and can alter the electrolyte levels in the body. As a result, it can cause dehydration and exhaustion.

Headache

A person affected with pustular psoriasis can have a fever and headache. Most of the time, the infected person may feel sick.

Nausea

Nausea is a common symptom of psoriasis, and it causes major discomfort.

Muscle weakness and joint pain

Pustular psoriasis can cause a lack of activity and stiffness. This can lead to muscle weakness and joint pain.

Anaemia

People infected with psoriasis will have poor iron storage and low blood count.

Weight loss

The link between weight loss and psoriasis are still not clear. Psoriasis is an inflammatory disease that makes the fat cells produce cytokines. This can have an impact on the symptoms.

Diagnosis

The diagnosis of pustular psoriasis depends on the presence of pustules and bumps on the outer skin. If there is a presence of scaly, red-glazed skin, a skin autopsy will be suggested.

Dermatologist

A person must consult a dermatologist (skin doctor) first for any skin ailments. By physical examination, the dermatologist will identify the type of skin ailment and the treatment for the disease.

The diagnosis will be based on the person’s

• Age
• Symptoms
• Type of psoriasis
• Medical condition
• Degree of infection
• Medication that can flare up the condition and
• Medications to mitigate the complications

After looking into the patient’s condition, the dermatologist will suggest the necessary treatment.

Biopsy

The skin biopsy is usually performed to be more clear and more specific about the type of psoriasis the person is affected with.

A patch of the affected skin is removed from the patient and then tested under a microscope to determine whether it is psoriasis or some other skin condition.

The skin biopsy gives a detailed report about psoriasis and the history of the disease. The test also determines the ability of the disease to spread.

Blood test

Blood test for pustular psoriasis is to find out any inflammation in the white blood cells. In some instances, the red blood cell level may be low, and the blood test will help to identify whether the person is anaemic.

The white blood cell count will be low if a person is infected with pustular psoriasis. And a person being anaemic may aggravate the condition of psoriasis.

Treatment

The treatment for pustular psoriasis will be based on the diagnosis. The doctor will prescribe the treatment based on the symptoms and their underlying condition.

Topical treatment

Topical treatment will be required when the patient’s symptoms are not very significant. After the application of ointments, the symptoms can be controlled.

However, the results of topical treatment may take up to six weeks to show any significant effect. If a person has some other medical condition, the medication can have an effect on psoriasis.

Hospital treatment

A person might require hospital treatment when they have adverse effects like the skin becoming red and itchiness that cannot be controlled. At these times, the person will require immediate hospitalisation, which can be life-threatening.

Biologic therapy

A biologic is a biopharmaceutical product that is extracted from living cells. These biologics isolated from humans, animals and microorganisms will be altered in the lab. Once the biologics are modified in the lab, they are safe to use.

Biologics are genetically altered to produce proteins that the body requires. The biologics may help mitigate the symptoms of psoriasis and will not cure them.

These drugs will be given as shots or administered intravenously. This will help the drug bypass the stomach acid, as they might digest the protein. When it is given directly, the biologics work effectively.

Biologics is recommended by the doctor when the symptoms are severe, and psoriasis has spread throughout the body. The major drawback of the treatment is it is costly.

Natural remedies

Pustular psoriasis requires medical treatment, and natural treatment may not have much effect on psoriasis.

Some natural therapy like taking a bath in salt water, an oatmeal bath and applying some oil-rich moisturiser may help keep your skin moisturised and prevent the skin from peeling.

However, these treatments may aggravate the condition and cause psoriasis to flare up. So, before taking such remedies, always consult your doctor.

A small, local outbreak

Small local outbreaks should be treated immediately to avoid a major outbreak. Corticosteroid ointments may help with local outbreaks. It can also be applied in sensitive areas like skin folds and in treating widespread patches.

These mild corticosteroid ointments can be applied during the flare-up of psoriasis, on alternative days, or during the weekends to reduce remission.

Widespread outbreak

Widespread psoriasis requires immediate medical treatment. In severe outbreaks, psoriasis affects 10% of your body, including the palm, face and skin folds.

The symptoms may aggravate, and major discomfort will be caused in the widespread outbreak. Corticosteroid ointments can work to an extent but will not be effective. So, it is advised to get immediate hospitalisation.

Prevention

Diet and hygienic practices may help with the prevention of psoriasis.

Quit smoking

Quitting the habit of smoking can help reduce the risk of psoriasis. According to a research paper published in NCBI, for people who smoke, the risk of psoriasis increases by 1.78% compared to those who do not smoke.

Quitting the habit of smoking can help to mitigate the symptoms and also reduces the risk of getting affected with psoriasis.

Avoiding unhealthful drinking amounts of alcohol

Consuming too much alcohol will be harmful to health. Overconsumption of alcohol can be risky and can flare up the symptoms of psoriasis.

Alcohol consumption will also increase the risk of psoriasis, according to a report published by the National Psoriasis Foundation.

When alcohol is consumed in high quantities, it can cause cellulitis. It is a bacterial skin infection that causes redness, swelling and pain in the infected area. It primarily affects the legs, can alter symptoms, and flare up psoriasis.

Avoid stress

We think there is no direct link between stress and psoriasis, but it is not true. A paper published in NCBI titled “Stress and psoriasis” stated that 31–88% of people complained stress was a factor that triggered psoriasis.

Getting enough sleep

Not getting good sleep can affect the immune system. This can weaken the immune system and cause skin infections like psoriasis. Lack of adequate sleep is considered as a risk factor for pustular psoriasis.

Following a healthful diet

Diet plays an important role when it comes to health. Foods like fruits, vegetables and whole grains contain nutrients and minerals required for the growth and development of the body. So always be mindful about your diet and the food you consume.

Risk factor

Use of some topical creams

The use of creams that are available in the markets can cause complications. It can aggravate the skin condition and lead to psoriasis. If a person is already affected with psoriasis, the application of such creams can flare up the symptoms.

Overexposure to UV light, for example, sunlight

UV rays from the sun can be harmful and can trigger the symptoms of psoriasis when overexposed to the sun.

However, the sun can heal major skin diseases. But if your doctor advises you to get sunlight for a limited time period, you can follow the instructions accordingly.

Some infections

Other skin infections can trigger psoriasis. Infections like cellulitis can trigger and flare up psoriasis.

Use of or withdrawal from certain internal medications

Sudden withdrawal from certain steroid drugs can cause skin diseases.

Corticosteroids

The application of corticosteroids can reduce the symptoms of psoriasis like swelling and itching. But over application can flare up the condition, and the symptoms can aggravate. If you have such symptoms consult your doctor immediately.

Conclusion

Psoriasis is an immune-system related condition. Pustular psoriasis is a rare type of psoriasis, and it cannot be treated at home. It requires immediate medical treatment.

If a person is diagnosed with pustular psoriasis, do not hesitate to consult the doctor. If treated at an early stage, the complications. If pustular psoriasis is left untreated, it can be life-threatening.

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