Pustular Psoriasis Symptoms, Causes, Diagnosis, Types and Treatment Options

What is Pustular Psoriasis? Key Symptoms, Types & Treatments

Pustular psoriasis is a subtype of psoriasis characterized by discolored skin patches and fluid-filled blisters. It can develop on any part of the body and can be painful if it breaks open. This condition can stay throughout one's life, and the flare-ups are the main issues that must be managed.

Keep reading to learn about the types, symptoms, causes, triggers, treatment, and other relevant details about pustular psoriasis.

What are the Types of Pustular Psoriasis?

Pustular psoriasis is divided into two types based on the area of the body it affects, and they are described in the following section:

1. Generalized: Also known as erythrodermic psoriasis, generalized psoriasis is a rare form of psoriasis that spreads rapidly and causes skin plaques. Pustules are also seen. Other symptoms of generalized psoriasis include chills, fever, severe itching, and muscle weakness. It can be chronic or acute.
    
2. Localized: Localized pustular psoriasis, also known as acute psoriasis, targets a specific part of the body and causes symptoms in that region. It has been divided into two parts: Palmoplantar Pustular Psoriasis and Acrodermatitis Continua of Hallopeau. The former form of psoriasis, also referred to as psoriasis on hands and psoriasis on feet, affects the hands and feet. Meanwhile, the latter form affects the fingertips and toes.
    

Apart from this, there are two other types of pustular psoriasis, and they are described in the following section:
 

1. Impetigo Herpetiformis: This is seen during pregnancy as a result of low calcium levels or any kind of infection. Pinhead-sized bumps are seen in groups around the scalp or neck. However, they don't manifest on the face, hands, or feet.
    
2. Annular or Circinate Pustular Psoriasis: Circinate psoriasis is not a severe form of psoriasis and is seen in a ring shape. The bumps formed in this case are red and scaly with pus.

What are the Symptoms of Pustular Psoriasis?

The typical symptoms of pustular psoriasis are mentioned in the following section:

• Mild pain around the bumps
• Itching
• Fluid-filled bumps or pustules
• Flaky and scaly skin or plaque
• Fever and chills
• Fatigue
• Muscle weakness
• Dehydration
• Swelling in the legs
• Tachycardia
   

Common sites for the pustules include:

• Hands
• Feet
• Scalp
• Face

What are the Causes of Pustular Psoriasis?

Pustular psoriasis is an autoimmune disease where the immune system becomes overactive and releases certain inflammatory molecules. As a result, the healthy skin cells divide more than what is required.

Apart from this, the dead skin cells form scales or flakes on the skin surface. The pustules are formed by the accumulation of neutrophils in the superficial skin layers.

What Triggers Pustular Psoriasis?

The actual reasons behind pustular psoriasis flare-ups are still unknown. However, the following factors are believed to trigger the condition:

• Stress
• Infection
• Stopping the intake of prescribed steroids
• Skin infections
• Skin irritants
• Hormonal imbalances
• Phototherapy
• Hypocalcemia
• Certain vaccines, such as H1N1, BCG, etc.
• Electrolyte imbalances
• Sunlight

What is the Treatment for Pustular Psoriasis?

The treatment of pustular psoriasis depends on the type and severity of the condition, which is described below in a detailed manner:

1. Local Outbreak
 

• For a small outbreak, the healthcare provider may prescribe topical creams for the sores. The scaly skin can be treated by using salicylic acid or coal tar, and the inflammation is reduced by synthetic vitamin D.
• The creams and ointments should be used continuously to prevent the skin from cracking. However, a cool compress on the spots might provide relief to the patients.
• Palmoplantar psoriasis and acropustulosis may persist for a long time, and hence, phototherapy might be prescribed.
   

Lastly, the immune system slows down with the use of Cyclosporine or Methotrexate. However, the patients should avoid smoking and alcohol if they are diagnosed with psoriasis.

2. Widespread Outbreak

• Prompt medical treatment is required if one is diagnosed with generalized pustular psoriasis.
• The treatment regimen includes fluids along with medicines such as Cyclosporine, Methotrexate, etc., to prevent infections and calm the immune system.
• The flare-ups are also controlled by a new antibody, spesolimab-sbzo, that blocks the signals to the immune system.
• Apart from these, the patient requires adequate rest and optimum hydration.

How to Control Pustular Psoriasis Flare-Ups?

Possible pustular psoriasis flare-ups are managed by following proper treatment. However, patients may still face them, and the following tips will help them manage the flare-ups:
 

1. Use a Proper Moisturizer

Using a moisturizer locks in the moisture, which helps with the plaques of dry skin. It is also known to heal skin and relieve symptoms. Some of the moisturizers include:

1. Emollients: Create a protective skin barrier.
2. Corticosteroids: Manage flare-ups.
    

Apart from this, some essential oils such as aloe vera, chamomile oil, and lavender oil also help lock in the moisture and heal the skin. Other tips to keep your skin moisturized include lukewarm showers, Epsom salt baths, and regular application of moisturizers.
 

2. Manage Stress

Stress is a significant factor during flare-ups, causing more inflammation. Hence, it should be properly managed using the following tips to help reduce the incidence of flare-ups:
 

1. Practicing relaxation techniques such as yoga, deep breathing, etc.
2. Consuming a healthy meal
3. Exercise
4. Limit screen time
    

Consult a psychologist or psychiatrist if the stress is affecting your mental health, and get help to help them live a stress-free life. 

• Avoid Smoking: Some experts say that avoiding smoking reduces the chances of inflammation and flare-ups. It also reduces the risk of affecting other vital organs.
• Quit Alcohol: Alcohol is known to worsen the symptoms of psoriasis owing to its inflammatory properties. Chronic consumption of alcohol in patients with psoriasis increases the chance of developing psoriatic arthritis.
• Get an OTC with Coal Tar: Coal tar is loaded with antibacterial properties, so OTC products like shampoos, soaps, ointments, and bath foams containing coal tar relieve the patient from flaking, dryness, and itching.

However, avoid the sensitive areas such as the face and genitals, as it may cause a hypersensitive reaction. Consult a healthcare professional if you notice any side effects or no effects at all. 

• Use Medicated Shampoos: Medicated shampoos help with the scaly plaques on the scalp. These help soften and loosen patches of psoriasis. However, avoid products containing fragrance and alcohol as they may aggravate the symptoms and worsen the conditions.

Pustular psoriasis is an autoimmune condition that persists lifelong and needs long-term treatment. It has been divided into subtypes depending on the area and type of pustular rash. With proper treatment, the patient can manage the flare-ups and live life without any serious health problems.