Pustular Psoriasis - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

As the name suggests, pustular psoriasis is a form of psoriasis dominated by small pus-filled bumps known as pustules. In some instances, this can have a predilection for the hands, feet, and nails and is referred to as localized pustular psoriasis. A generalized form also occurs in which any part of the body can be involved.

Symptoms

Pustules are white pus-filled bumps and are typically associated with underlying redness. In some people, there is intense itching. Of note, the pustules in this condition are not due to an infection and are considered “sterile.” 

Causes

This condition can occur with no known underlying cause or disease. It can also occur after or at the same time as an infection, after rapid decrease of a systemic steroid, or in association with pregnancy. Recently a gene mutation in the interleukin-36-receptor antagonist has been identified in association with pustular psoriasis.[1]  

 

Treatments

Steroids: Topical steroids can be used to control the inflammation on the skin. Unlike systemic steroids, topical steroids do not lead to a flare of pustular psoriasis. 

Immunosuppressants: Systemic therapies include retinoids, biologic medications and other immunosuppressants (ex: cyclosporine).[2,3]

Light treatment: Phototherapy combined with oral medication or a medicated hand soaks have also been successful. 

1.    Marrakchi S, Guigue P, Renshaw BR, et al. Interleukin-36-receptor antagonist deficiency and generalized pustular psoriasis. N Engl J Med.2011;365(7):620-628; PMID: 21848462.

2.    Sevrain M, Richard MA, Barnetche T, et al. Treatment for palmoplantar pustular psoriasis: systematic literature review, evidence-based recommendations and expert opinion. J Eur Acad Dermatol Venereol.2014;28 Suppl 5:13-16; PMID: 24985558.

3.    Levin EC, Debbaneh M, Koo J, et al. Biologic therapy in erythrodermic and pustular psoriasis. J Drugs Dermatol.2014;13(3):342-354; PMID: 24595581.