Psoriasis is a common inflammatory condition of the skin. However, pustular psoriasis which is characterized by a white pustules surrounded by red skin, is rather rare. The condition is seen mostly in adults and is usually localized to certain areas of the body but can be generalized. Pustular psoriasis often occurs in a cycle which starts with a reddening of the skin followed by formation of pustules and scaling.
The most common places that these pustules appear are in the genital area and the bends and folds of the skin. These pustules can appear on the face but it\’s highly unusual. If they occur under the nails it will cause the nails to come off.
Within a day of appearing the pustules fuse together and form large areas of pus, dry and peel off in sheets. Underneath, the skin is smooth and red on which new pustules appear. This cycle can go on for days to weeks. In two to three month period of time a phase involving hair loss can happen.
Individuals will also suffer other symptoms such as headache and fever. But, once the pustules improve the other symptoms will also disappear. Individuals who have never suffered from pustule psoriasis in the past should visit their physician if a rash of raised pus filled pimples appears on the skin. Other symptoms that may appear also are fever, chills, joint pain a feeling of general discomfort, decreased appetite and nausea.
In most cases there is no identifiable cause found for generalized pustular psoriasis. The medical terminology for this is idiopathic, which means no identifiable cause. Some people have a previous history of chronic plaque psoriasis, a more common variety, while others may find they recently were treated with corticosteroids, had an infection, were pregnant or are taking drugs such as lithium, indomethacin, iodide and some of the beta-blockers. These factors appear to be triggers for pustular psoriasis.
Individuals who suffer from pustular psoriasis will have their disease classified into one of several types depending upon the symptoms. The symptoms will either be sudden and severe (acute), a long-term (chronic) or somewhere in between (subacute). In some cases individuals will suffer a generalized pustular psoriasis with acute symptoms of fever and a toxic reaction that results in a ring shape. In this case the individual will require hospitalization for treatment.
During your physical examination the doctor may also perform a few blood tests looking for a specific changes that occur in individuals who have pustular psoriasis. A complete blood count should reveal reduced lymphocytes and a large number of polymorphonuclear leukocytosis. A blood test for sedimentation rate will be elevated and blood chemistry will reveal increased plasma globulin and decreased albumin, calcium and zinc. Your physician may also order a blood culture to determine if any organisms are growing in the blood and a urine sample to assess creatinine levels and determine if there is any disorder of the kidneys. The doctor will probably also perform a culture of one of the pustules which should be negative.
Individuals who suffer from generalized pustular psoriasis are usually admitted to the hospital to ensure adequate fluid intake. The skin is the largest organ in the body and responsible for temperature regulation and fluid regulation. If enough of the skin is damaged because of the condition the individual may have difficulty maintaining their temperature which puts a huge strain on the heart.
Along with supportive therapy, doctors may also order a topical drugs, phototherapy or systemic therapies to help decrease the condition and stabilize the individual. Medications may be used to reduce the symptoms and improve the complications of the disease. These may include topical corticosteroids, vitamin D3, coal tar, anthralin or retinoids. These systemic medications can include Enbrel, Rehumatrex, Cyclosporine, Alefacept or methotrexate.
Once discharged from the hospital patients will be advised to avoid triggers which may initiate another flareup. These can include smoking, increased sun exposure, alcohol or increase stress.
Individuals can suffer from significant complications which may include bacterial skin infections, hair loss, abnormally low amounts of albumin in the blood, low amounts of calcium, kidney damage, liver damage or malabsorption in the gastrointestinal tract. For these reasons it is important for an individual who believes he may be suffering from pustular or psoriasis to seek medical care from his primary care physician or dermatologist. This particular type of psoriasis should never be attempted to be treated using natural remedies at home.
RESOURCES
National Psoriasis Foundation: Types of Pustular Psoriasis
http://www.psoriasis.org/about-psoriasis/types/pustular
National PSoriasis Foundation: Pustular Psoriasis Fact Sheet
http://www.psoriasis.org/document.doc?id=524