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Pustular Psoriasis: What Makes It Unique?

Pustular Psoriasis: What Makes It Unique?

Psoriasis is a skin inflammation that presents in various forms. One of these is pustular psoriasis. What triggers this skin disease and how can we deal with it? Here's an overview of the key points to remember about pustular psoriasis.

Summary
Published February 19, 2024, by Manon, Scientific Editor — 5 min read

How to recognize pustular psoriasis?

Pustular psoriasis is a term referring to a rare form of psoriasis that is non-contagious skin condition. Its prevalence is estimated at 2 cases per 1 million people. Pustular psoriasis is characterized by a sudden and widespread outbreak of superficial sterile pustules. They are non-infectious, but inflammatory. These pustules are the size of a pinhead and can merge with each other.

The lesions caused by this disease can be localized in a specific area or spread across all parts of the body. They are accompanied by pain, a burning sensation, or itching in some patients. It happens that the same individual may suffer from both pustular psoriasis and plaque psoriasis. In this case, the plaques of the rash can be scaly and erythematous. There are a few rare cases where the pustules reach the tips of the fingers and toes. Generally speaking, pustular psoriasis can affect any individual of any age.

Pustular psoriasis presents itself in two forms:

  • Palmoplantar Pustulosis (PPP): This term is used when the lesions of the disease are concentrated on the hands or the soles of the feet.

  • Generalized Pustular Psoriasis (GPP): this term is used when the lesions of the disease spread over the entire body.

Pustular psoriasis may be accompanied by the following systemic symptoms:

  • Chills;

  • Fever or headaches;

  • A generalized discomfort;

  • Joint pains;

  • Sensations of burning;

  • Affliction of the lips (psoriatic cheilitis).

Pustular Psoriasis: What are the Causes?

The abrupt discontinuation of corticosteroid-based treatments in patients with plaque psoriasis is often the first cause identified as a trigger for pustular psoriasis. Generally, the products used for these treatments are gradually discontinued when they are prescribed for more than 5 days.

Pustular Psoriasis is not caused by poor skin hygiene or bacteria. It originates from a genetic factor associated with an overactive immune system.

One of the suspected causes of the frequent onset of this pathology is the administration of certain medications such as aspirin derivatives and lithium or the initiation of certain drugs like ustekinumab.Tobacco use and stress are not triggering factors for this disease, but they can exacerbate its flare-ups.

Complications related to this disease can occur for a variety of reasons, including secondary bacterial infection, hypoalbuminemia, hypocalcemia, renal tubular necrosis, or malnutrition. Furthermore, untreated patients have an increased risk of cardiorespiratory failure. Mortality data from studies on patients with GPP are limited, but rates of 3% and 7% have been reported.

How to treat pustular psoriasis?

Immediate intervention is necessary in the case of palmoplantar pustulosis psoriasis due to the pain it can cause. The treatment is based on topical corticosteroids such as ointments, creams, or lotions. If this option proves ineffective, doctors turn to phototherapy or drug treatments using Methotrexate, Cyclosporine, or Acitretin.

For cases of pustular psoriasis on the nails, the treatment involves injections of corticosteroids under the nails. This treatment inflicts intense pain on the patients, which compels doctors to suggest phototherapy or the use of nail polish based on urea instead.

Complications are not uncommon with generalized pustular psoriasis. It is advised to consult a doctor as soon as symptoms appear. Treatment may include the prescription of retinoid-derived medications or phototherapy sessions.

Sources

ZELICKSON B. D. & al. Generalized pustular psoriasis. A review of 63 cases. Archives of Dermatology (1991).

CHOON S. E. & al. Clinical profile, morbidity, and outcome of adult-onset generalized pustular psoriasis: analysis of 102 cases seen in a tertiary hospital in Johor, Malaysia. International Journal of Dermatology (2014).

GOODERHAM M. J. & al. An update on generalized pustular psoriasis. EXPERT REVIEW OF CLINICAL IMMUNOLOGY (2019).

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