Psoriasis Health Center

Pustular Psoriasis

Pustular psoriasis is an uncommon form of psoriasis. People with pustular psoriasis have clearly defined, raised bumps on the skin that are filled with pus (pustules). The skin under and around these bumps is red. Large portions of the skin may redden.

	Pustular psoriasis. Note the clearly defined, raised bumps on the skin that are filled with pus (pustules). The skin under and around these bumps is red.

The skin changes before, during, or after an episode of pustular psoriasis may be similar to those of regular psoriasis. People with the usual skin symptoms of psoriasis have patches of raised skin with scales.

Pustular psoriasis is classified into one of several types, depending on symptoms. They may be sudden and severe (acute), long term (chronic), or somewhere in between (subacute). The generalized type affects the whole body with more than just skin symptoms. A generalized type with acute symptoms, fever, and a toxic reaction in the tissues is called the von Zumbusch type. A ring-shaped (annular, or circinate) type has also been described. It is usually subacute or chronic, and people with this type do not usually have symptoms aside from the skin symptoms. Pustules may be localized to the palms and soles (palmoplantar pustulosis). The least common type is the juvenile, or infantile type, which occurs in children.

Pustular psoriasis is not common. In Japan, only about 7.46 people per 1,000,000 have pustular psoriasis. Pustular psoriasis affects all races. In adults, it affects men and women equally. In children, it affects boys somewhat more often than girls. The average age of people with pustular psoriasis is 50 years. Children aged 2-10 years can be affected, but this is rare.

Causes of Pustular Psoriasis

Pustular psoriasis has been associated with the following causes: 
 

• Taking systemic steroids (steroid medications given by mouth or by injection) and then discontinuing them
• Various drugs, including the following:
  • Salicylates, compounds made from salicylic acid, often used to treat pain and fever
  • Iodine, a topical antiseptic
  • Lithium or trazodone, antidepressants
  • Phenylbutazone or oxyphenbutazone, nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Penicillin, an antibiotic
  • Hydroxychloroquine, a drug for malaria
  • Calcipotriol, a type of vitamin-D
  • Interferon alfa and recombinant interferon-beta injections, chemotherapy drugs
• Strong, irritating topical solutions (creams or ointments applied to the skin), including tar, anthralin, steroids under occlusion, and zinc pyrithione in shampoo
• Infections
• Pregnancy
• Sunlight or phototherapy
• Cholestatic jaundice (a yellowish staining of the skin and eyes, caused by bile)
• Hypocalcemia (abnormally low levels of calcium in the blood)

 In many people, the trigger is never identified.

Pustular Psoriasis Symptoms

In the generalized type of pustular psoriasis, the skin is initially fiery red and tender. You may have symptoms such as headache, fever, chills, joint pain, a feeling of general discomfort or uneasiness, decreased appetite, and nausea. Within hours, you may see clusters of pustules.