Pustular Psoriasis
by Edward F. Group III, DC, ND, DACBN
updated on 04/28/2006 at 05:14PM
What Is Pustular Psoriasis?
Pustular psoriasis is a rare form of the skin disease called psoriasis. It is also known as Von Zumbusch psoriasis. Unlike most types of psoriasis, pustular psoriasis can be life threatening, especially for those with weakened immune systems, such as the elderly. This condition can affects men and women of all races. And it usually affects adults more than children. In fact the average age for the development of pustular psoriasis is fifty. However, this condition has also been seen in young children and teenagers as well.
Pustular psoriasis is characterized by widespread pustules that form on the background of red and tender skin. Patches of affected skin can occur randomly on any part of the body, although it develops most frequently on flexural areas such as the backs of the knees, the insides of the elbows, the armpits and the groin. The pustules continue to grow and spread until they merge to form large areas of pus. They can rupture easily and become infected, causing dehydration and increasing the risk of infection.
There are two types of pustular psoriasis: generalized or localized. Generalized pustular psoriasis is the common term used to describe the condition when it strikes the body. Localized pustular psoriasis appears only on hands or feet.
What Causes Pustular Psoriasis?
In many cases, there is no identifiable cause for an outbreak of pustular psoriasis. Some people who develop this type of psoriasis have a previous history of chronic plaque psoriasis, a much more common form of the condition. Others may have an outbreak of pustular psoriasis triggered by the sudden withdrawal of injected or oral corticosteroids.
These steroids may briefly clear up an outbreak of psoriasis, but after the patient discontinues their use, he or she typically experiences an outbreak of even greater severity. Other possible triggers for pustular psoriasis include exposure to medications (such as lithium, salicylates, indomethacin, iodide and some beta-blockers); a recent infection; pregnancy; or an allergic reaction to a topical medication such as coal tar or dithranol.
What are the Signs and Symptoms of Pustular Psoriasis?
Pustular psoriasis usually starts off as patches of dry, skin that is fiery red and tender. The sufferer may also experience a fever, chills, increased heart rate, headache, loss of appetite, nausea and muscle weakness. Within a few hours of the initial onset, small pustules, about two to three millimeters in size may begin to appear. These pustules will be filled with non-infected pus. After one or two days, the pustules will grow and spread, merging together to form large areas of affected skin. These pustules will then dry and peel to leave behind a glazed, smooth surface of skin. Subsequent pustules may appear on this new skin, with the cycle continuing to repeat itself every few days.
Patients who experience pustular psoriasis may be alarmed by the sudden onset of the condition. Complications such as dehydration and infection are common with this condition. And once remission occurs, the psoriasis may revert to a more common form. In addition, relapses of pustular psoriasis are quite common.
How Serious Is Pustular Psoriasis?
Generalized pustular psoriasis can be a very serious condition. For those with a weakened immune system, such as elderly patients, the disease can be life threatening. Therefore hospitalization is often required. Pustular psoriasis must be treated aggressively to prevent excessive fluid loss, normalize the body temperature and restore one's electrolyte imbalance. Pustular psoriasis also causes changes in the blood that must be monitored. These changes include lowered calcium levels (hypocalcaemia), low zinc levels, low plasma albumin, high erythrocyte sedimentation rate (ESR), raised neutrophil count, decreased lymphocyte count and raised lactate levels.
What Complications Are Associated With Pustular Psoriasis?
Unlike other forms of psoriasis, pustular psoriasis is a very serious condition. It can even be life threatening in severe cases or when a patient's immune system is weakened. Death can result from cardiorespiratory failure during the acute phase of this condition when the pustules are forming and spreading. Therefore, it is critical that patients are treated as quickly as possible. Other complications that can develop as a result of pustular psoriasis include secondary infections; dangerous chemical changes within the blood (such as altered levels of calcium and other minerals); kidney and liver dysfunction; malabsorption of nutrients and other medications; and inflammatory arthritis.
