What to Know About Pustular Psoriasis, According to Dermatologists

The life-threatening condition causes pus-filled bumps.

Typically, psoriasis—a chronic, inflammatory skin condition—shows up as red patches that have a silver, scaly appearance. Pustular psoriasis is a little different, and can actually be quite serious.

Pustular psoriasis is characterized by white pustules (or blisters of pus) surrounded by red skin, according to the National Psoriasis Foundation (NPF). But—and this is important—pustular psoriasis is not contagious. “Because it shows up as pustules, people often assume there’s an infections component to it but there isn’t,” says Lindsey Bordone, MD, a dermatologist at ColumbiaDoctors and assistant professor of dermatology at Columbia University Medical Center in New York City. The pus inside those pustules is actually made up of white blood cells, is not from an infection.

It's because of these pustules, that pustular psoriasis is often misdiagnosed. "“Pustular psoriasis looks very different from plaque psoriasis,” Dr. Jessica Kaffenberger, a dermatologist and principal investigator in psoriasis clinical trials at The Ohio State University Wexner Medical Center, tells Health. Some patients, for example, may "suffer from extreme pain as the pustules make it very painful to use your hands or walk without experiencing extreme pain.”

There are also two specific types of pustular psoriasis: generalized pustular psoriasis (GPP), which is often widespread throughout the body; and palmoplantar pustulosis (PPP), which predominantly appears on the hands and feet, says Dr. Kaffenberger.

While PPP is often less severe, GPP may require immediate medical care, per the American Academy of Dermatology (AAD). "GPP patients can get very sick with fevers and increased white blood cell counts," Dr. Kaffenberger adds. "If this occurs, these patients will need to be hospitalized." In addition to the widespread pustules, GPP also symptoms also include fever, chills, dehydration, and a rapid pulse.

As far as triggers go, there are a few different causes for a pustular psoriasis flare-up, according to the NPF, including different medications, pregnancy, overexposure to UV light, infections, and emotional stress.

How is pustular psoriasis treated?

Like other forms of psoriasis, there are several ways dermatologists treat pustular psoriasis. And, while some patients respond to steroid creams and ointments, others require oral medications or phototherapy, which uses UVB light to treat involved areas of skin.

“Treatment protocols are dictated by how much body surface area is involved,” says Dr. Adarsh Vijay Mudgil, MD, a board-certified dermatologist and dermatopathologist, and owner of Mudgil Dermatology in New York City. “For localized skin involvement, topical treatments with steroid creams or ointments generally suffice. For more widespread disease, systemic therapy is generally required, which can involve either oral medication (like methotrexate, acitretin, or cyclosporine) or injectable biologic medications (like Enbrel, Humira or Stelara).”

Treatments for more severe GPP may include monitoring electrolytes, which is why hospitalization is necessary. "We’ll look at blood calcium levels, which can be dangerously low in these patients," says Andrew Miner MD a dermatologist in Rockledge, Florida. “Many of the best treatments for GPP are fast acting and include medications like cyclosporine (sometimes used in patients with organ transplants) or infliximab (an intravenous medication that attacks a pro-inflammatory molecule called tumor necrosis factor).”

Interestingly, some patients with GPP have been found to have a mutation in a molecule called interleukin-36, adds Dr. Miner. “For these patients, future treatments may include more targeted therapies involving interleukin-36-related molecular pathways,” he says.

In the end, experts urge patients with this form of psoriasis to should seek treatment from a dermatologist as soon as possible. “Often, a multi-pronged approach is needed to restore quality of life,” Dr. Kaffenberger says.

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