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VERIFIED CONTENTAuthor: lek. Tomasz Nęcki

Pustular psoriasis is a fairly rare form of psoriasis, which is also one of the more severe types of this disease - it can even lead to a life-threatening condition. As with other types of psoriasis, the causes of the disease remain unclear. How to recognize this disease? What are the symptoms of pustular psoriasis? What is the prognosis of patients who will develop this problem? Is the treatment of pustular psoriasis effective?

Pustular psoriasis(Latinpsoriasis pustulosa , Pustular psoriasis) is basically one of the less common forms of psoriasis.

In different regions of the world this unit is found with a different frequency, for example, according to Japanese statisticspustular psoriasisis diagnosed in slightly more than 7 per million people.

It is most common in people in their 50s and in patients of this age, the frequency of the disease is similar in men and women.

In general, pustular psoriasis is rare, but it is even less common in children than in adults, although it is also possible. Typically, the course of the disease in children is milder than in adults.

Pustular psoriasis: causes and risk factors

Like the etiology of other types of psoriasis, the causes of pustular psoriasis are not entirely clear.

So far, medics have been able to observe that psoriasis is an autoimmune disease, i.e. one in which abnormal responses of the human immune system are involved.

It is also characteristic of the individual that in its course there is an exceptional acceleration of the multiplication of epidermal cells, but what directly leads to disorders appearing in the course of psoriasis - it is not really known. Currently, the dominant view is that the disease is influenced by genetic burden and environmental conditions.

In the case of the former, such a view was made on the basis that it is noticeable, for example, that people whose families have had psoriasis have an increased risk of psoriasis themselves. As for the environmental factors that influence the occurrence of various forms of psoriasis - including pustular psoriasis - a number ofvarious problems.

Well, there is a link between pustular psoriasis and many different aspects - the following are the following risk factors for psoriasis:

  • smoking
  • use of various drugs (including non-steroidal anti-inflammatory drugs - NSAIDs, mood stabilizing drugs - e.g. lithium preparations or interferon preparations)
  • sudden discontinuation of previously used glucocorticosteroids for a long time
  • skin injuries
  • experiencing high stress
  • skin irritation (both by various chemicals and UV radiation)
  • pregnancy

Pustular psoriasis: types

The group of pustular psoriasis includes several entities in which skin lesions appearing in patients are essentially similar, although they are located in different parts of the body. The differences also include the presence of additional (apart from dermatological) symptoms of a given form of pustular psoriasis, as well as the severity of the disease. Considering the above, the following are mentioned:

Generalized pustular psoriasis(also called von Zumbusch's psoriasis) - is considered to be the most severe form of psoriasis. In this case, in patients purulent pustules appear on the entire surface of the body (usually with the exception of the face), apart from them, patients may also notice significant reddening of the skin and Nikolski's symptom (a phenomenon in which the epidermis creases after rubbing the skin).

Characteristic of generalized pustular psoriasis is that patients also experience the so-called general symptoms such as fever, headache, nausea or a general feeling of weakness, joint pain and chills.

Pustular psoriasis of the hands and feet- changes appear in the palms and fingers, as well as in the soles and toes. It is characterized by the fact that patients experience pain (due to the location of pustules in the above-mentioned locations) and that women suffer from pustular psoriasis of the hands and feet more often.Pustular psoriasisof hands and feet may coexist in the patient with other psoriasis lesions (e.g. resulting from ordinary psoriasis) or it may precede them.

Continuous pustular dermatitis of the extremities-the most limited form of pustular psoriasis - in this case, psoriatic lesions appear in the phalanges of the distal fingers and toes.

Pustular psoriasis: symptoms

A characteristic symptom of pustular psoriasis are pustules that vary in size (usually a few millimeters) and are filled withpurulent content.

Although it may seem otherwise, the content of the pustules is actually sterile - it does not contain bacteria, but it contains white blood cells.

It is quite interesting that the patient's skin lesions may appear in a very short time - for example in the case of generalized pustular psoriasis, pustules may appear on most surfaces of the body even within less than one day.

Apart from pustules, the symptoms of patients with pustular psoriasis also include reddening of the skin or various other skin lesions - it may be that the patient will also have typical psoriatic plaques. There may also be the aforementioned general symptoms of pustular psoriasis (generalized).

Pustular psoriasis: diagnosis

The clinical picture of a patient withpustular psoriasisis usually quite characteristic and a dermatologist can diagnose the disease just after carefully examining the skin lesions.

Usually, however, patients are ordered various tests - primarily laboratory tests - which not only allow for an accurate assessment of their condition, but also for differential diagnosis.

In patients, it can be performed, among others :

  • blood count (leukocytosis can be detected)
  • ESR test (there may be an increase in it)
  • blood protein tests (there may be an increase in the concentration of globulins with a simultaneous decrease in blood albumin)

Patients may also be ordered to undergo bacteriological tests - this is to exclude a possible infectious etiology of skin lesions.

Pustular psoriasis: treatment

Treatment of pustular psoriasis can be extremely different - it all depends on the type of disease in a given patient and its stage.

The most dangerous is generalized pustular psoriasis, which usually requires treatment in a hospital setting. In this case, it is necessary to counteract infections (for this purpose, patients may be given antibiotics), care for adequate hydration of patients, as well as the use of topical medications on the skin. Patients may need to be treated with oral glucocorticoids.

The treatment of other types of pustular psoriasis is different - pustular psoriasis of the hands and feet or continuous pustular dermatitis of the extremities. In their case, typically, much less advanced treatment is sufficient, and additionally, only the use of topical medications may be sufficient to improve the condition of patients.

In general, it is difficult to come across specific treatment regimens for individual charactersPustular psoriasis - Typically, a combination of different approaches generally used to treat psoriasis is implemented when looking at the benefits for the patient.

In the treatment of pustular psoriasis, the following are used :

  • cygnolina
  • Dziegcie
  • glucocorticosteroids
  • retinoids
  • methotrexate
  • cyclosporins
  • phototherapy
  • photochemotherapy
  • biological drugs

Pustular psoriasis: prognosis

The prognosis of patients with pustular psoriasis depends primarily on which form of this disease occurs in them. The most serious is generalized pustular psoriasis - it can even lead to the death of the patient, e.g. due to renal failure, sepsis or liver failure.

The other forms of the disease are definitely less dangerous, but this does not mean that they are trivial - they have a tendency to relapse.

There is even a situation where a patient who was diagnosed many years earlier, e.g. pustular psoriasis of the hands and feet, who was treated and whose skin lesions completely disappeared after a few, and sometimes even several years, experiences another episode of the disease .

Also read:

  • Psoriatic arthritis (articular psoriasis, psoriatic arthritis)
  • Nail psoriasis (psoriatic nail changes)

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Category:

Dermatology