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What is Pustular psoriasis? Pustular psoriasis or sometimes referred to as generalised pustular psoriasis is a type of psoriasis that is characterized by skin lesions or blisters filled with pus. The lesions sometimes occur in clusters and could be very painful. The pus is non-contagious and it’s not an infection at all. The skin around the pustules turns red and tender.
The condition is often rear and affects all races, men and women of older age equally with no exceptions. But with children, it affects them between the ages of 2 and 10 years old and tends to show up on boys more than girls
Often times when people ask what is pustular psoriasis? They also want to know how it plays out with other types of psoriasis. We will also be looking at the psoriasis cure as it relates to pustular psoriasis.
Sometimes pustular psoriasis can co-exist with plaque psoriasis or one following after the other but both are very different. The main difference between the two are the white pustules found in pustular psoriasis, these are absent on plaque psoriasis.
Here are some more distinguishing features of pustular psoriasis-
-The skin in and around the pustules is usually red
– It affects mostly the arm, the elbows and the knees, it rarely affects the face
– The pustules may also occur under the nails and as well as on the tongue.
– Apart from the hands, legs and knees, it can also spread very rapidly all over the body.
– The pustules and blisters will eventually turn brown and crusty and peel off later exposing shiny and scally skin.
– The circles of appearing, fusing and peeling off and reappearing again might last for weeks, making the patient uncomfortable and exhausted.
-The ring shaped type of pustular psoriasis is much more common in children than adults with less severe symptoms than in the generalised type of pustular psoriasis.
In the ring shaped plaque psoriasis, the plaques are elevated when they show up. You will find pustules all around the edges of the ring. The edges normally expand and the centre heals.
-In children, pustular psoriasis is often times are mild and you might see other symptoms of psoriasis beside the normal pustular psoriasis symptoms.
-For the palms and soles of the feet, pustular psoriasis in these areas is usually chronic and maybe associated with bone or joint inflammation leading to psoriatic arthritis. Usually when the pustules appear on these areas, they are white and yellow as they fill up with pus.
What causes pustular psoriasis is quite similar to the causes of plaque psoriasis. Though generally, all forms of psoriasis is triggered by a combination of genetic and environmental factors. But below are some factors known to be associated with pustular psoriasis and most are what triggers pustular psoriasis:
1- The use of strong and irritating topical solutions such as creams and soaps containing tar,
anthralin, steroids, and zinc pyrithione in shampoo.
2- Too much exposure to sunlight and phototherapy
3- Suddenly stopping the use of systemic steroids.
4- Taking other medications such as:-
-Salicylates, and compounds made from salicylic acids that are mostly used to treat patients with pain.
-Vitamin D derivatives and Calcipotriol
-Penicillin and some kinds of antibiotics
-Lithium or trazodone, and taking antidepressants
6- Having an unusually low level of calcium in the blood stream; a condition known as Hypocalcemia.
Having dealt with what is pustular psoriasis? There are different types of pustular psoriasis and accompanying psoriasis cure but first the different types include:
Palmer-Plantar Pustulosis (PPP)
This is sometimes called palmoplantar psoriasis. This is usually a localised form of pustular psoriasis that acts on the palms of the hands hence the name. But they are also found on the soles of the feet. This type of pustular psoriasis is more common with people between the ages of 20 and 60 years old and a lot more in people that smoke.
In PPP, when the pustules do show up, they are very large and about 5mm in diameter on the hands and feet such as the thumbs and the sides of the heels. Gradually, the pustules dry up, turn brown and then gradually fade away or peel off. This type is usually cyclical, when they old fade; new ones come up to replace them. Sometimes the skin do crack open in these areas and they are very painful leading to some form of loss of functionality especially in the hands.
Acrodermatitis Continua Of Hallopeau
This is also referred to as Acropustulosis. This form of pustular psoriasis is usually rear than the rest. Like PPP, it appears on the hands, the heels and the toes as well. Here, when the pustules burst, it exposes bright red patches that sometimes ooze.
This type can cause deformity in the toenails and bones of the fingers if left untreated. They are normally triggered by skin injury and sometimes by infections.
Von Zumbuschi Pustular Psoriasis
This is also called generalised pustular psoriasis. This form of pustular psoriasis normally begins with pains on the areas that are affected and those areas turn red. Within a matter of hours, pustules are formed and they dry up within a day or two.
The areas affected are very itchy and the patient may experience fever, chills, and dehydration. This is usually treated as an emergency since it could be life threatening.
Like most other types of psoriasis, this particular type of pustular psoriasis also comes and goes in circles. It most times can lead to weight loss, and its potential complications include, hair loss, nails loss, secondary bacterial infection and as well as liver damage. This type of pustular psoriasis is rear in children.
Pustular psoriasis treatment is very crucial and urgent when it comes to psoriasis cure and most especially pustular psoriasis because this is one form of psoriasis that could be life threatening. In situations like these, patients are normally hospitalised and kept under strict observation.
This is to prevent more dehydration, stabilize body temperature and the restoration of electrolyte imbalance. Most times doctors need to rotate treatments to avoid further complications especially with the stronger medications.
Studies have shown that the combination of of acitretin (brand name Soriatane) and methotrexate is usually very effective in checking pustular psoriasis. Below are the treatments for specific types of pustular psoriasis-
-Generalised Pustular Psoriasis treatment
All forms of pustular psoriasis require immediate medical attention and generalised pustular psoriasis is no exception. The doctors will have to rehydrate the body system after substantial loss of fluids, the patient will need to have his or her temperature stabilised.
Systemic medications for generalised pustular psoriasis include:
-Antibiotics for infections
-Biologic agents like infliximab, etanercept etec
This is one form of pustular psoriasis that has been hard to treat. But a good combination of topical preparations may help. For others, systemic medications may be all they need to get relief.
-Palmoplantar pustular psoriasis treatment
Here doctors find it easier to first use topical treatments before considering other options that are stronger treatments. The other options may include; including PUVA, UVB, acitretin, methotrexate or cyclosporine.
-Pustular Psoriasis Therapies
Apart from the various psoriasis treatments mentioned above, there is still other alternative pustular psoriasis therapies and remedies available. Mostly these are home cure for psoriasis that you can apply at home Some of these psoriasis home remedies may include:
– Diet changes,
-Stress-reducing techniques to help reduce symptoms.
Aside from the fact that psoriasis is a genetically motivated illness which of course means that there is little you can to prevent it; but you can also help by making sure that you stay away from those things that can trigger a flare up for you. And some of these can be applied to general psoriasis treatment are:
-Avoid any environmental factors like too much sun exposure, smoking and too much alcohol intake. These will serve to help you have a stronger immune that will have a better chance at fighting the condition.
-There are really no specific dietary restrictions but generally eating good food and staying as healthy as you should; will save you a lot of pain and heart ache.
When the condition does flare up:
-Seek immediate admission to the hospital
-There should be intensive nursing and care, paying attention to the level of body fluids, and temperature regulation.
-Endeavour to use bland or topical compresses and saline or oatmeal baths. These will help soothe the affected areas and give you some relief.
-Secondary bacterial infection of the skin
-Poor circulation and general toxicity may lead to liver failure.
-Malabsorption and malnutrition may occur
In the United States alone, of the close to 7.5 million people suffering with psoriasis, erythrodermic psoriasis afflicts just about 1 to 2 percent of them.
It afflicts older adults than younger people and it has a male to female ratio of 2:1 to 4:1. More men develop the condition than women. This form of psoriasis sometimes occurs together with pustular psoriasis and those with unstable plaque psoriasis. That shows that the lesions have no clearly defined edges to it. It could best be described as wide spread fiery red patches covering almost the entire skin surface.
Those people with erythrodermic often look like burn victims but the patches are not burns. Because of its fatal nature, doctors advise treating it as a medical emergency. The good news is that it’s very rear and only affects about 3% of those with psoriasis.
Some of the signs and symptoms of psoriasis are
-It’s highly inflammatory
-There is deep skin redness and peeling off of the red scales almost on the entire body area.
-The peeling is always in large sheets unlike small patches peeling in normal psoriasis.
-As the skin peels, it is followed by very deep pain and itching as well.
-The entire body temperature is thrown off balance; the patient’s temperature may rise at short notice.
-The patient heart rate could also spike at any time and especially if the environment around the patient is very hot.
-There could be sever protein loss
-There could also be the loss of fluid
-The loss of fluid may lead to certain areas of the body like the ankles to retain fluid unnaturally causing those areas to swell (Oedema)
– Erythrodermic Psoriasis could also lead to heart failure and pneumonia
-There could also be other infections due to the complete failure of the skins ability to protect itself.
-For those patents with a combination of erythrodermic psoriasis and pustular psoriasis; they may experience zumbusch psoriasis. This is a condition where there is a severe electrolyte imbalance in the body system.
-The imbalance will generally lead to muscle weakness, and even fever itself.
– Erythrodermic psoriasis follows the unset of plaque psoriasis especially in people whose plaque psoriasis is unstable. Though, in rear cases for some people, Erythrodermic psoriasis might be their first ever case of psoriasis eruption.
-Suddenly stopping any systemic treatments
-If there is high degree of calcium deficiency (Hypocalcaemia) in the body
-Suddenly stopping the use of strong coal tar preparations
-Suddenly stopping the excessive use of strong topical corticosteroids
-Severe sunburn could also trigger the condition
-Taking too much alcohol
-Doctors will normally take blood samples, or blood cultures to find out if there is renal failure.
-They also check for inflammatory markers too
-They also run tests to determine if there is anaemia
-Also check for hypoalbuminaemia
The treatment of Erythrodermic psoriasis could be tricky and difficult but it could be managed. The patient must be hospitalized to monitor fluid and protein losses and make sure they are stabilized by giving them intravenous fluids. And also to keep their temperature balanced.
But initially, doctors might start off treatment with the use of less strong topical steroids, moisturizers combined with wet dressings and as well as Oatmeal baths to reduce redness and swelling. This will also sooth the pain and itching. Patients will also need plenty of bed rest.
-Application of Systemic Medications
These are oral medications which are much more effective in bringing severe cases under control. The include-
-Cyclosporin, which is an anti-rejection drug which helps to slow the immune response that causes psoriasis.
-Inflimixab, this is another drug that is used to treat autoimmune diseases just like Cyclosporin above. These two drugs are fast acting drugs.
-Acitretin and cancer drug methrexate are much slow acting drugs but are equally as effective.
Words of caution in using systemic medications; these drugs have potential side effects and must be used under strict supervision. To stop using these drugs also must be gradual; suddenly stopping them can trigger a flare of psoriasis.
Sometimes it pays to combine some or all of these medications in some cases. That is a combination of topical and oral treatments. It’s been known that combining two or more medicines might be more effective than just using one.
The patient may also need to be given pain relievers for comfort, anti-depressants to help patients sleep better and have better mood. Also, doctors may prescribe drugs to help with the itching and antibiotics to help fight other infections or skin infections.
Phototherapy treatment should not be used at least in the early stages of treatment of erythrodermic psoriasis because they may well worsen the condition.
Related Erythrodermic Psoriasis Links