Pustular Psoriasis
| Figure 3.8
A: Pustular psoriasis
B: Palmoplantar psoriasis*
C: Palmoplantar psoriasis*
*Courtesy of Dr. Paul Getz |
(Figure 3.8A–C) - Distinct from psoriasis vulgaris in both features and clinical course
- ↑ HLA-B27 incidence
- Two types: generalized and localized (palmoplantar pustulosis, acrodermatitis continua suppurativa)
- Generalized (von Zumbusch)
- Presents initially with malaise and fever, subsequent onset of erythematous macules studded with sterile pustules; initially in intertriginous areas but quickly spreads to trunk, extremities and nails (skin feels painful), ↑ risk for infection
- Risk factors: tapering oral corticosteroid, infection, hypocalcemia, pregnancy (impetigo herpetiformis)
- Labs: leukocytosis, hypoalbuminaemia
- Treatment: correct electrolyte and protein imbalance, methotrexate or cyclosporine (avoid systemic corticosteroid), later treatment can include phototherapy or biologic treatment
• Palmoplantar pustulosis- Tense, sterile pustules over palmoplantar surface with yellow-brown macules; may be associated with SAPHO syndrome (so prudent to inquire about any sternoclavicular tenderness and/or back pain)
- Treatment: acitretin, topical corticosteroid
• Acrodermatitis continua of Hallopeau - Variant of pustular psoriasis limited to finger tip or digit; HLA-B27 association
- Presents with sterile pustules on erythematous base at tip of finger (less likely on toe) forming lakes of pus, associated pain and impaired use of digit; if pustules within nail bed, nail will typically be shed; may have loss of bony structures
- Treatment: topical calcipotriene, topical corticosteroid, acitretin
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