Pustular psoriasis can be limited either to the palms, soles, or fingertips, or can be part of a generalized exacerbation of psoriasis vulgaris.
When on the palms and soles, the pustules can be associated with vesicles. When on the trunk, well demarcated 2-4 mm superficial flaccid pustules can erupt in sheets over the body surface. These pustules are frequently surrounded by erythema.
There may be evidence of a more chronic psoriasis elsewhere. There may be an associated fever and malaise.
Chronic pustular psoriasis of the fingertips, often with bone and nail destruction, and arthritis, is known as Acrodermatitis continua of Hallopeau.
Culture and Gram-stain of the pustule contents are negative for bacterial pathogens.
Pustular psoriasis of the palms and soles can be extremely resistant to therapy.
- Treatment generally involves the use of potent topical steroids.
- Occasionally, systemic agents such as cyclosporine or methotrexate are necessary.
Generalized pustular psoriasis responds usually quite well to bland therapy.
- It is very important to avoid any irritants such as anthralin for generalized pustular psoriasis.
- 1 % hydrocortisone ointment applied topically may result in good improvement.
- Systemic cyclosporine and methotrexate may be needed if the disease does not respond well to such topical therapy.
- When a more stable plaque-type psoriasis is present, treatment with PUVA can be considered.
- Hospitalization is often necessary.
- Acute attacks can be life-threatening.