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Therapeutics in Dermatology
A reference textbook in dermatology

Pustular psoriasis

14 October 2021, by NOGUEIRA M. & TORRES T.

1 - OVERVIEW

Pustular Psoriasis is a term that comprises a group of rare skin diseases that share the presence of multiple small pinhead-sized pimples in the skin. The most common diseases identified in this group are Palmoplantar Pustulosis (PPP) and Generalized Pustular Psoriasis (GPP). The skin lesions might be limited to a particular region of the body or widespread. This group of diseases can appear at any age or ethnicity.

2 - SIGNS AND SYMPTOMS

Multiple small pimples emerging in a red skin is the typical presentation, which can be localized in a specific region of the body (as in PPP, with palms and/or soles affected) or have a widespread distribution (as in GPP). Some patients might report a burning sensation, pain, or pruritus associated with those lesions. Desquamative and erythematous plaques might be present in the same individual and are probably related to another disease called Plaque Psoriasis, that is sometimes present in the same individual.

Patients suffering from Pustular Psoriasis can also develop systemic symptoms such as fever, chills, general malaise, joint pain, headaches, conjunctivitis, labial involvement, or nail changes (thicker or dystrophic).

3 - WHO GETS THE DISEASE AND CAUSES

Pustular Psoriasis is not contagious. Current knowledge seems to indicate that genetically susceptible individuals, when exposed to several triggering factors (including smoking, systemic steroids, infections, drugs, stress, pregnancy, metal allergy, electrolyte imbalances), might develop any of these diseases. However, it is important to mention that only a few genes are currently identified, and the vast majority of patients developing PP may have mutations in genes that still need to be determined.

4 - DIAGNOSIS AND TREATMENT

Clinical history, physical examination, and sometimes complementary investigations comprising blood tests and a skin biopsy are needed to clarify the diagnosis.

Identification and discontinuation of the triggering factor is important and may help in disease control. When that is not possible/enough, there are several options to control the disease in patients with PP, such as topical and systemic drugs. Phototherapy is reserved for specific cases and is an option that has to be discussed between patient and clinician. New drugs (biological agents) are now being tested with promising results that may change the paradigm of treatment of these diseases in the future.

5 - TIPS FOR MANAGING

5.1 - THINGS YOU SHOULD DO

  • Identify a possible triggering factor and avoid it;
  • Keep the skin lesions clean and dry after bath to reduce the risk of infection (use antiseptics in pimples);
  • Comply with the treatment prescribed by your doctor;
  • Use emollients to improve skin symptoms.

5.2 - THINGS YOU SHOULD NOT DO

  • Take any prescription until you talk to your doctor

5.3 - ASK FOR AN URGENT APPOINTMENT IF

  • The skin disease has rapidly evolved despite treatment;
  • Different lesions have emerged on your skin, or the characteristics of the ones you previously had have changed significantly;
  • Other symptoms besides skin lesions are uncontrolled (fever, chills, joint pain, headaches).

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