Pustular Psoriasis

What is pustular psoriasis?

Pustular psoriasis is a form of psoriasis that looks like scaly, discolored patches of skin with fluid-filled blisters or pustules. Psoriasis can form anywhere on your body. It can be painful and sore if pustules break open. Psoriasis is a chronic condition that can come and go throughout your life.

Who does pustular psoriasis affect?

Pustular psoriasis affects people diagnosed with psoriasis. Psoriasis is a skin condition that affects millions of people in the United States. An estimated 3% of people diagnosed with psoriasis experience pustular psoriasis symptoms at least once during their lifetime. Pustular psoriasis can affect anyone diagnosed with psoriasis at any age, but it’s more common among adults than children.

Is pustular psoriasis rare?

Pustular psoriasis isn’t rare, but a type of pustular psoriasis called generalized pustular psoriasis is the rarest form of psoriasis. Generalized pustular psoriasis causes symptoms of psoriasis that affect a large area of your body. Additionally, you may have symptoms like a fever and muscle weakness accompanying the quickly spreading psoriasis plaques on your skin.

What’s the difference between palmoplantar pustulosis and pustular psoriasis?

Pustular psoriasis is a type of psoriasis that causes skin plaques with pustules or blisters anywhere on your body. Palmoplantar pustulosis, which is also known as palmoplantar pustular psoriasis, is pustular psoriasis that affects only your hands and feet.

What’s the difference between pustular dermatosis and pustular psoriasis?

Pustular dermatosis is a skin condition that causes pus-filled blisters to form under the top layer of your skin (subcorneal layer). These pustules usually form in areas of your skin where there’s friction, like in your groin or underarms. While pustules are the main symptom of both pustular dermatosis and pustular psoriasis, dermatosis doesn’t cause skin plaques of flaky, discolored skin.

What are the types of pustular psoriasis?

There are two types of pustular psoriasis based on how and where they affect the skin on your body:

• Generalized: Generalized pustular psoriasis (GPP), or erythrodermic psoriasis, is the rarest form of psoriasis. It quickly spreads to a large area of your skin and causes skin plaques with pustules, as well as a fever, chills, severe itchiness, muscle weakness and fatigue. If you have any of these symptoms, visit your healthcare provider immediately. GPP can be long term (chronic) or short term.
• Localized: Localized pustular psoriasis (acute psoriasis) targets a specific part of your body and causes symptoms on your skin. Two common forms of localized pustular psoriasis include palmoplantar pustular psoriasis, which affects your hands and feet, and acrodermatitis continua of Hallopeau, which targets the tips of your fingers and toes.

What are the signs and symptoms of pustular psoriasis?

Signs and symptoms of pustular psoriasis could include:

• A patch of thick, discolored, flaky and scaly skin (plaque).
• Skin patch covered in fluid-filled bumps (pustules) or blisters.
• Mild pain or itchiness.

The pustules on your skin can join together with other fluid-filled bumps and burst open. This can make your skin feel tender and sore. When pustules burst, new pustules can form in the same location.

Generalized pustular psoriasis symptoms

It’s common for pustular psoriasis to cover a small area of your body, like the palm of your hands, and cause just local symptoms. Although rare, pustules on plaques can cover a large area of your body. This is called generalized pustular psoriasis, and you may experience additional symptoms that could include:

• Fever and chills.
• Muscle weakness.
• Fatigue.
• Severe pain and itchiness.
• Fast heart rate.
• Dehydration.
• Swollen legs.

If you experience symptoms of pustular psoriasis and symptoms of generalized pustular psoriasis, contact a healthcare provider immediately.

Where will I have symptoms of pustular psoriasis?

Symptoms of pustular psoriasis can affect any part of your body where you have skin. Common sites for symptoms include your:

• Feet.
• Scalp.
• Face.
• Hands.

What causes pustular psoriasis?

An overactive immune system causes pustular psoriasis. Your immune system keeps your body healthy by defending itself against foreign invaders like bacteria. These invaders can make you sick. If you have psoriasis, your skin immune system becomes overactive and releases inflammatory molecules that cause healthy skin cells to divide and replicate too quickly, which causes dead skin cells to form on the surface of your skin as scales or flakes. This state of immunologic over-activity also causes certain cells from the immune system call neutrophils to collect in the most superficial layers of the skin, which causes pustules.

What triggers pustular psoriasis?

Irritants or allergens in your environment can trigger symptoms of pustular psoriasis. Common triggers include:

• A reaction to a medication.
• Changes to your routine.
• Stress.
• Ultraviolet exposure.
• An infection (streptococcus or staphylococcus).

Is pustular psoriasis contagious?

No, pustular psoriasis isn’t contagious. Even though the fluid that can leak out of your pustules looks like an infection, it isn’t. You can’t spread psoriasis to other people through physical contact.

How is pustular psoriasis diagnosed?

A healthcare provider will diagnose pustular psoriasis after a physical examination. They’ll ask you questions about your symptoms and take a complete medical history. The visual appearance of your symptoms usually leads to an accurate diagnosis, but your symptoms may look similar to other conditions so tests might be necessary. Your provider might offer a culture test, a skin biopsy and/or an allergy test to confirm a diagnosis. If your provider suspects generalized pustular psoriasis, they may also want to collect blood for tests, such as a complete blood count.

You may need to see a dermatologist to diagnose and treat psoriasis.

How is pustular psoriasis treated?

Treatment for pustular psoriasis focuses on:

• Clearing the pustules from your skin.
• Relieving symptoms of itchiness or pain.
• Preventing side effects like an infection if pustules break open.

A healthcare provider will offer a treatment plan that could include:

• Topical medications, ointments or creams.
• Phototherapy.
• Oral medications.
• Biological treatments.

How soon after treatment will I feel better?

It can take a couple of weeks to a few months before your skin completely clears up after a flare-up of symptoms of pustular psoriasis. Treatment usually works in stages to clear the pustules, prevent the build-up of dead skin cells on the surface of your skin that causes scaling and reduce skin discoloration. If you’re concerned about the timeline for your treatment, talk with your healthcare provider so you can feel better sooner.

How can I prevent pustular psoriasis?

You can’t prevent pustular psoriasis, but you can reduce your risk of a flare-up of symptoms by:

• Washing your skin with a gentle cleanser or soap often.
• Using a moisturizer regularly.
• Managing your stress.
• Avoiding triggers that cause symptoms.

What can I expect if I have pustular psoriasis?

Psoriasis is a chronic, lifelong condition. You may experience symptoms that come and go throughout your life. There isn’t a cure for pustular psoriasis. Your healthcare provider can help you manage your symptoms and identify triggers.

When you get a flare-up of symptoms, try to keep track of any irritants or allergens that may have triggered it. If you notice patterns when you have symptoms and when you contact certain things or feel stressed, those could be triggers. To avoid recurring flare-ups, avoid those triggers. If you’re having trouble identifying your triggers, talk to a healthcare provider.

When should I see my healthcare provider?

Visit your healthcare provider if you:

• Have symptoms that get worse after treatment.
• Experience signs of an infection, including severe pain, swelling or a fever.
• Have symptoms that aren’t going away after treatment.
• Have symptoms that affect your ability to thrive.

When should I go to the ER?

Visit the emergency room if you have symptoms of generalized pustular psoriasis, which includes pustules on skin plaques in addition to:

• A fever.
• Muscle weakness.
• Severe pain.
• Itchiness.

What questions should I ask my doctor?

• What caused my psoriasis to flare up?
• How do I prevent an infection if my pustules break open?
• What should I do if the pustules prevent me from using my hands or feet?
• Are there side effects to the treatment?
• How often should I use topical medications on my skin?

A note from Cleveland Clinic

Pustular psoriasis can be a frustrating condition to manage, as your symptoms can cause skin irritation that can come and go unexpectedly throughout your life. Some people diagnosed with psoriasis find comfort in speaking with a mental health professional if their symptoms affect their self-confidence or self-esteem. A healthcare provider can help you manage your symptoms. If you experience symptoms of pustular psoriasis and symptoms of generalized pustular psoriasis, like widespread skin plaques, a fever and muscle weakness, visit your healthcare provider immediately.