Pustular psoriasis manifests as a Localized or Generalized Pustular variant. The first one usually affects the feet and the hands. If it is spread throughout the body, it is called generalized pustular psoriasis. Great part of the skin is inflamed and dotted with plaques.
Pustular psoriasis affects less than 5% of those suffering from this disease; it can appear as a complication of plaque psoriasis, after taking certain medications or for having abruptly suspended the therapy that was being used for a long period.
Pustular psoriasis comes in two types, localized and generalized, in relation to the extension and severity of the clinical manifestations. Both are characterized by the same skin lesion, typically a yellowish sterile pustule with a diameter of a few millimeters on erythematous patches.
Usually it affects the soles of the feet and the palms of the hands, actually called palmoplantar psoriasis. Lesions can develop on their own or accompany a vulgar psoriasis. Two variants are known: the palmoplantar psoriasis of Barber and the acrodermatitis continua of Hallopeau, in this last variant there can be compromise of the periungual and nail bed that leads to the nail dystrophy. For those affected is painful to walk and often they are no longer able to perform a manual labor.
If it is spread throughout the body, as occurs in severe cases, it is called generalized pustular psoriasis of von Zumbusch type. It is the most frequent pustular variant. The patient presents fever of several days of evolution followed by the abrupt development of sterile pustules that spread throughout the trunk and limbs including palms, soles and nails. The erythema is progressive until the development of erythroderma which is the universal red state of the skin. It has a mortality of around 30%.
There is a variant of pustular psoriasis of pregnancy known as impetigo herpetiformis with typical onset during the last trimester of pregnancy, is characterized by recurrence in subsequent pregnancies.
The causes of pustular psoriasis
The etiology of pustular psoriasis is not yet fully known. It is known, however, that the beginning of the eruptions can be caused by different triggering factors including the psychophysical stress and the harsh environmental situations. In certain individuals certain drugs (lithium, iodine, beta-blockers and others) may weaken the immune system and promote psoriasis. The suspension of the use of steroidal compounds can lead to psoriatic manifestations. Other causes are the skin's exposure to chemicals and allergens, various types of trauma, abrasions up to surgery and burns. Even streptococcal infections can sometimes trigger psoriasis. In some patients, psoriasis is caused by deficiencies of calcium and dialysis.
Patients with generalized pustular psoriasis require hospital admission, systemic antibiotic therapy, electrolyte balance control, and specific systemic therapy such as: retinoids (of choice), methotrexate, cyclosporine, or biological therapy.
Localized forms require topical treatments such as corticosteroids, topical retinoids, calcipotriol and in refractory cases systemic retinoids, cyclosporine at low doses or biological agents. In these cases we also recommend the Psotherapy Moisturizing and Regenerating Cream for its anti-inflammatory, moisturizing and emollient action that improves the condition of the skin without adverse effects.
This form of psoriasis often manifests itself after an episode of pharyngitis, tonsillitis or otitis caused by group A beta-hemolytic streptococcus, with appearance similar to small red drops covered by the usual pearly whitish scales, with a dimension that varies from a few millimeters up to 1.5 - 2 cm. Sometimes a disseminated macular rash can manifest this type of psoriasis first.
The areas in which guttate psoriasis most commonly appears are the trunk, upper arms, thighs and scalp.
This type of psoriasis can disappear within a few weeks spontaneously, but in particularly stubborn cases it can become plaque psoriasis and it is necessary to follow a controlled treatment in consultation.
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