Pustular psoriasis (pustular psoriasis): symptoms, treatment, etc.

Definition

What is pustular psoriasis (pustular psoriasis)?

Pustular psoriasis skin disease (pustular psoriasis) is a type of psoriasis characterized by the appearance of pustules, small, white, pus-filled bumps surrounded by a red, inflammatory hue.

These symptoms make pustular psoriasis easier to distinguish from more common types of psoriasis such as psoriasis vulgaris and inverse psoriasis.

Pus in pustular nodules is made up of white blood cells, but this does not indicate infection and is not contagious. However, the symptoms caused can cause severe skin damage. Therefore, pustular psoriasis can be said to be the most serious and difficult to treat skin disease among other types of psoriasis.

Based on differences in the affected body parts, severity, and reactions to medical treatment, psoriasis pustulosa is divided into 3 types, namely:

• Generalized pustular psoriasis, symptoms appear in a wider area of ​​the body, can appear suddenly and the disease progresses rapidly.
• Palmar-plantar pustulosa (PPP), symptoms that arise only on the palms of the hands or soles of the feet
• Acropustulosis (Acrodermatitis continua of Hallopeau), symptoms appearing on the tips of the fingers or toes, are very rare and usually appear after an injury to the skin.

How common is pustular psoriasis?

Pustular psoriasis is the rarest case. According to the Indonesian Psoriasis Care Foundation, the number of people with pustular psoriasis is only 5% of the total psoriasis sufferers.

Adults are the most common group of sufferers. The appearance of symptoms is usually limited to the feet and hands, except in patients who have generalized pustular psoriasis.

In most cases, the symptoms of pustular psoriasis can appear as an early symptom or progression of the condition psoriasis vulgaris.

Signs & symptoms

What are the signs and symptoms of pustular psoriasis?

Pustular psoriasis symptoms actually vary depending on the type. In general, the symptoms are shown with characteristic signs in the form of blistered skin with white rashes (pustules) that are similar to acne.

A white rash on top of a red skin rash that indicates inflammation of the skin. This skin problem can cause intense itching and burning at one time.

If the pustular nodule ruptures, it will discharge pus. After breaking, the pustules will eventually crust and form ulcers.

Here are the different symptoms of the 3 types of pustular psoriasis.

1. Generalized pustular psoriasis

Generalized pustular psoriasis is also known medically as Von Zumbusch psoriasis. Inflammation can occur suddenly with the spread of the pustules throughout the body which can last for 24-48 hours.

Pustular psoriasis symptoms spread to almost all parts of the body. Apart from skin lesions, this type of pustular psoriasis can also cause other health problems such as:

• fatigue,
• fever,
• headache,
• muscle weakening, and
• joint pain (psoriasis arthritis).

This type of psoriasis is among the most dangerous, so it requires emergency medical treatment. Very intense inflammation of the skin can cause dehydration of the skin, accelerate the heart rate, and increase the risk of infection.

Therefore, people who develop generalized pustular psoriasis need intensive care in a hospital.

2. Palmar-plantar pustulosa (PPP)

Pustular psoriasis symptoms are only found in certain areas of the body, namely the palms of the hands or feet. Often, this symptom appears on the underside of the thumbs and on both sides of the ankles.

Initially the symptoms appear in the form of reddish plaques which then turn brown and cause the skin to peel so that it crusts up.

Symptoms appear based on certain cycles. Therefore, pustular nodules can reappear after healing. This group of sufferers who often experience psoriasis are active smokers.

3.Acropustulosis (Acrodermatitis continua of Hallopeau)

In acropustulosis, the lesions (abnormal skin tissue) are characterized by small, painful rashes that appear on the fingers or big toes. Later, these skin lesions can spread to all parts of the palms and feet.

These lesions can be very painful and irritating and even tend to damage parts of the nails (also called nail psoriasis). Sometimes this skin inflammation can occur when there is a previous wound or skin infection.

When should I see a doctor?

You need to immediately see a doctor for an examination, when you experience skin inflammation that shows symptoms like the above. This is especially true when the symptoms have persisted for a long time, have not improved, and have raised other health complaints.

Conditions that indicate that you need an examination to get medical treatment are as follows.

• Continues and makes you sick and uncomfortable so that it interferes with daily activities.
• Makes you worry about your appearance.
• Causes joint problems, such as pain, swelling or other diseases that interfere with daily activities.
• Difficult to do daily routine.

Cause

What causes pustular psoriasis?

Each type of psoriasis has been reported to be associated with an immune system disorder or autoimmune disease. When the immune system, which is in charge of fighting viral and bacterial infections, attacks healthy skin cells, new skin cells will grow faster.

However, the cause of this type of psoriasis cannot be determined with certainty. The role of the immune system in the mechanism of symptom progression in each type of pustular psoriasis also needs to be thoroughly investigated.

However, it is strongly suspected that this condition is associated with inflammation that occurs suddenly and rapidly in the transition area between the outermost layer of skin (epidermis) and the layer below it (dermis).

Apart from causing a number of skin disorders, pustular psoriasis inflammation also causes the death of most of the white blood cells in the skin. As a result, there is an accumulation of splenic fluid which forms festering pustules with dead white blood cells.

Risk factors

What increases my risk of developing pustular psoriasis?

This skin disease can be triggered by various things, namely the side effects of drugs, exposure to skin irritants, pregnancy, excessive exposure to ultraviolet rays, and stress.

Several things can increase the likelihood of developing pustular psoriasis and make the condition worse, causing irritation. The worsening of the symptom is usually characterized by a rash that gets redder.

In the case of psoriasis vulgaris, the skin problem you experience can develop into psoriasis pustular symptoms due to the following psoriasis triggers.

• Certain drug reactions.
• Use of topical drugs or shampoo with steroid doses, coal tar , anthralin , and zinc pyrithione the strong one.
• Take prednisone that was stopped suddenly.
• Skin infection.
• Phototherapy side effects.
• Pregnancy.
• Stress.

Diagnosis

How do doctors diagnose this disease?

To diagnose this disease, medical personnel who are usually skin specialists will perform a physical examination to identify symptoms. The doctor will then investigate whether you have a condition that is a risk factor.

Because pustular psoriasis is common in people with a history of psoriasis vulgaris, your doctor will also ask you about any history of skin diseases you have had.

There is usually no need for blood tests or other laboratory tests to confirm a diagnosis. From these three evaluations, doctors can get a definite picture of pustular psoriasis.

If further testing is needed to confirm the diagnosis, the doctor will take a sample of pustular nodules which will then be checked for bacterial or viral infections. Pustular psoriasis is not affected by infection.

Treatment

What are my treatment options for pustular psoriasis?

The goal of psoriasis treatment in general is to clear the pus-filled lumps, relieve symptoms such as pain, itching, fever, and reduce the risk of complications. In mild cases, treatment is also useful for preventing infection, restoring normal temperature as well as the chemical balance of the skin.

The drugs used are usually oral retinoids, cyclosporine, methotrexate, and oral PUVA drugs, namely drugs derived from psoralen and ultraviolet A rays.

Again, the right treatment for this disease needs to be tailored to the type of pustular psoriasis. The doctor will also perform treatment depending on the severity of the disease or if you have other medical conditions.

For generalized cases of pustular psoriasis, treatment should be carried out intensively in a hospital. Meanwhile, the types of PPP and acropustulosis can go through the use of drugs on an outpatient basis.

Here are more specific treatments for each type of pustular psoriasis.

Generalized pustular psoriasis

Some of the drugs most doctors use to treat this condition are oral retinoids and infliximab.

Oral retinoids are oral retinoids that are derived from vitamin A. The drug has an anti-inflammatory component that works to treat inflammation that occurs when a patient has psoriasis. This drug can also help maintain the immune system. Some of the drugs included in oral retinoids are acitretin, alitretinoin, and bexarotene.

Meanwhile, infliximab is a biological product drug that can reduce inflammation and swelling of the bumps that appear quickly. Because the patient's body usually reacts quickly to this drug, its use is often the first choice when the patient's generalized pustular psoriasis is severe.

Both of these drugs are efficacious, but there are some patients who may not be suitable for use.

Therefore, the doctor will provide other medicines. Some that may be prescribed include apremilast, methotrexate, cyclosporine, or other biologic drugs such as adalimumab or etanercept.

In patients whose symptoms do not improve, the doctor may give oral steroids.

Palmar-plantar pustules (PPP)

Topical drugs or topical drugs in the form of creams and ointments are preferred to treat early symptoms. Some of the options are synthetic corticosteroids and vitamin D creams. Sometimes doctors will prescribe a combination of corticosteroid cream with salicylic acid.

Complementary treatment can be done using acitretin, cyclosporine or methotrexate.

Acropustulosis (Acrodermatitis continua of Hallopeau)

These psoriasis symptoms are among the most difficult to treat. Therefore, systemic medications and topical medications are needed to remove the skin lesions and restore the affected nails.

The method of treatment that is often used to treat this condition is the administration of synthetic vitamin D combined with a strong corticosteroid. In addition, some patients also undergo PUVA treatment, in which patients must take psoralen medication before getting UVA light therapy on the affected skin.

Home remedies

What are some lifestyle changes or home remedies for pustular psoriasis?

It is almost difficult to prevent psoriasis because of the complex mechanisms that cause skin inflammation and the triggers for psoriasis, which are sometimes difficult to avoid.

However, at least you can still reduce the risk of pustular psoriasis by doing the following ways.

• Quitting smoking, PPP is more common in active smokers.
• Avoid exposure to direct sunlight.
• Manage stress by doing activities that are relaxing.
• Reducing excessive alcohol consumption.