Pustular Psoriasis – Symptoms, Causes and How To Treat It

Pustular Psoriasis

Although there are many forms of psoriasis, pustular psoriasis is among the ones which occur relatively rarely. This can be clearly distinguished given the raised and well defined bumps that are visible throughout the skin. The bumps contain liquid (pustular fluid), usually clear or yellow. A very common symptom in this form of psoriasis is reddened skin, caused due to inflammation. It can be safely said that Pustular psoriasis seems similar to the regular occurrence of the condition in many ways before it eventually takes the final form. In fact, once the bout of pustular psoriasis is done with, it again tends to look very similar to usual psoriasis. However, health experts will tell you that this rare form of psoriasis is visibly less scaly than the general occurrence of psoriasis, and this is precisely why your reddened skin is all the more visible. Pustular psoriasis can either be acute or chronic, though this largely depends on the length of the condition. Moreover, the condition can become very severe if not taken care of in its early stages, the reason being that it affects your entire body as it spreads, and can cause fluid as well as temperature imbalance within the body.

Pustular Psoriasis

Symptoms of pustular psoriasis

Before we begin discussing the topic in detail, it is important to highlight the symptoms associated with pustular psoriasis. Some very commonly seen symptoms in this case include itchy and painful skin, and white blisters surrounded by red skin are easily visible. The most affected areas are trunk, legs and arms, although it must be noted that it can develop anywhere. Additionally, a patient suffering from pustular psoriasis will also complain of fever and Zumbush-type, and these are caused due to toxic reactions that take place in tissues. The medical community has determined the disease to be sub-acute or chronic because of its ability to engulf the entire body.

Types of pustular psoriasis

There are separate types of pustular psoriasis, amongst which Von Zumbusch is known to be the severest. In fact, this is dangerous enough to cause life threatening risks, and the patient must be under medical supervision at all times. This particular form of psoriasis leads to a quick outbreak on a relatively large area of the skin. You can see the pustules coming up very quickly, and they dry equally quickly, thereby leaving the skin sensitive to touch. Some other symptoms in this case include chills, fever, intense itching and also severe dehydration. Von Zumbusch pustular psoriasis can also cause anemia, exhaustion and an increase in your pulse rate.

Palmoplantar psoriasis is another form of psoriasis that occurs on your palms and soles. The appearance of the initial pustules in this case is more like a studded pattern, and red skin plaques are easily visible at the top. However, these tend to become brownish and crusty with the passage of time. Recurrence of this form of pustular psoriasis is common.

Acropustulosis is one other form of this condition, and is known to occur relatively rarely. This affects your finger and toe tips, and a skin injury or infection is most likely the cause. However, this form of pustular psoriasis is painful, and can result in deformed nails. If not treated early, this can even have an adverse effect on your bones. Additionally, it must be mentioned that acropustulosis is quite difficult to treat, and your doctor may choose alternative treatment methods to help you get rid of the disease.

Although all forms of psoriasis should be treated with equal concern, palmoplantar psoriasis affects less people than the other two. This type of psoriasis affects people of all races, and men and women are equally prone to fall prey to this condition.

Causes of pustular psoriasis

There is no single cause which can be held completely responsible for the onset of this disease. In fact, there is a wide variety of them. These range from extensive use of powerful steroids to unintended application of skin irritants. In this section, we briefly discuss the numerous causes of pustular psoriasis.

A very common cause of this condition is when a patient is on a high dose of steroids and stops taking them abruptly. Additionally, it is not just steroids one should be aware of. There are several others, and these largely include trazodone, aspirin and similar salicyclates, penicillin, anti inflammatory medications, iodine topical preparations and lithium. Moreover, this form of psoriasis can also be caused due to skin irritants such as anthralin, coal tar, zinc shampoo and occlusive steroids.

PhototherapyCertain infections are also known to trigger pustular psoriasis. Medical experts have determined that liver jaundice, low levels of blood calcium and phototherapy can play an important role in triggering this condition, although this does not happen generally. Skin injury is one other factor which can lead to pustular psoriasis.

Surprisingly, pregnant women also run the risk of having pustular psoriasis. It is only natural that a female body undergoes several changes during this stage. Confusion or malfunctioning which occurs in the immune system can trigger this medical condition.

Prolonged exposure to sunlight is known to be a cause for numerous skin issues. The radiation from which the body suffers can also lead to skin cancer, as well as pustular psoriasis. Scientists have discovered that this radiation causes an adverse effect on our T cells, thus causing them to change. This ultimately results in confusion among the cells, which then malfunction and attack the skin. Doctors strongly suggest the application of sun blocks for those who are exposed to sunlight for long hours, and essentially for those prone to skin issues.

Stress is another important factor that must be considered. It is no surprise that stress is blamed for numerous health issues, pustular psoriasis being one of them. Stress is actually a psychological issue, and our body is not equipped to deal with it, and this result in our body reacting to it in several ways. Most results caused due to stress, such as anxiety, pain, exhaustion, and aches, confuse our immune system, thus causing it to malfunction. This malfunction later leads to the system attacking the body.


The medical community labels pustular psoriasis as a severe medical condition and the patient must be kept under medical supervision at some point or the other. An excellent way of determining whether you are suffering from this disease is a blood test, which your doctor will also recommend if he or she sees the symptoms. People affected with the skin disorder typically have lower blood calcium levels and an equally low amount of zinc in their body.

The eruptive phase of the disorder is quite fatal, and is capable of leading to bacterial infections and a host of liver problems. Fluid loss becomes common in this case, and this is one more reason why the patient must be closely observed.

Treating pustular psoriasis

Although there are a number of ways in which pustular psoriasis can be treated, the actual treatment largely depends on the severity of the condition. Hospitalization becomes essential to cover fluid loss and maintain proper body temperature. Moreover, this form of psoriasis also causes strain on a patient’s heart, and there are increased chances of stress or heart injury. Compresses become an ideal form of treatment in this case, and health experts recommend saltwater solution and oatmeal baths to initiate healing of the pustules. This is also necessary to inhibit any chances of secondary infection.

In addition to the above mentioned treatment options, health experts also suggest using topical agents for healing pustular psoriasis. These very commonly include agents such as corticosteroids, anthralin, coal tar preparations, retinoids and vitamin D3 analogues. Now, it is not uncommon for a patient to try several of these medications alternatively. In fact, doctors recommend rotating these to derive the maximum benefits from these agents. For example, anthralin is known to work best when mixed with salicylic acid in a cream or ointment.

Coal tar soap

Light therapy is one other form of treatment for pustular psoriasis. The light used for treatment can either be natural sunlight, or your doctor may recommend the use of special UVA or UVB lamps. Now, due to the fact that UVB light is stronger than UVA, a separate medication is used to sensitize the skin. This is called psoralens, and the light therapy involving the use of this medication is known as PUVA. However, there are some side effects associated with this therapy, skin cancer and burns being the most common.

There are other alternative treatment options for pustular psoriasis. Systematic therapy is gradually becoming popular, and more so because it counters the inflammatory effect related with the disease. This form of therapy involves using biologics or retinoids, and this work well when used in addition to light therapy. This therapy requires the patient to be injected after every two weeks.

Von Zumbusch pustular psoriasis treatment

The Von Zumbusch psoriasis is also known as the generalized form of pustular psoriasis, and is distinguished red skin spread over large areas. This is a painful condition, and the red skin later leads to the formation of pustules. However, the pustules, in this case, get dried and fall off very quickly, possibly within a couple of days. This eventually leads to malfunctioning of the skin’s natural protective functions, and is a fatal condition. Symptoms of this form of pustular psoriasis commonly include dehydration, fever, chills, intense itching, muscle weakness and a rapid pulse rate.

Health experts recommend seeking medical aid as soon as you experience these symptoms. Your doctor will have you diagnosed, and the initial medical response is towards the restoration of your skin’s integrity. Needless to say, your doctor will begin by prescribing antibiotics to counter the infection in your skin. If your condition involves excessive dehydration, you will also need to get hospitalized. Once your doctor determines that you have stabilized, then comes the actual treatment phase. He or she may suggest several medications to inhibit the over production of your skin cells, which is common in all cases of psoriasis. Some very popular medications used in this case are Methotrexate, acitretin and cyclosporine. At later stages, your doctor might suggest the use of light therapy combined with an oral drug.

Palmoplantar pustulosis treatment

Medically abbreviated as PPP, and more commonly known as the localized form of pustular psoriasis, this condition is characterized by pustules formation on the palms and soles of a patient. The condition begins with the reddening of the skin, and later turns to pustule formation that are brown and peeled. Topical medications work best in this situation, and your doctor may recommend the use of medications containing salicylic acid, synthetic vitamin D and corticosteroids. Topical retinoids is a class of drugs that is known to be significantly beneficial in this case. However, if the symptoms in your case become persistent, your treatment may also involve UV light therapy, acitretin or cyclosporine.

Acropustulosis treatment

This is a relatively rare form of pustular psoriasis, and affects fingertips and toes. Skin lesions tend to become visible, and this eventually leads to painful deformities in the patient’s nails. This may also affect your local bone structure. The method of treatment is quite the same as is used for the treatment of other forms of pustular psoriasis. However, you must also understand that this is a tricky condition, and it may take a while before your doctor determines the best treatment form for your situation.

Side effects associated with pustular psoriasis treatments

Although the medications and treatment methods mentioned above are beneficial for the cure of pustular psoriasis, many of these are associated with serious side effects. This is also why health experts recommend on using alternative medications. Rotating through various forms of treatments significantly minimizes the risk of complications. For increased safety, you may also ask your doctor about the side effects of the medications he or she prescribes.

Home remedies for treatment of pustular psoriasis

Skin care: In addition to being immensely painful at times, blisters caused due to psoriasis also serve as the breeding ground for numerous germs and bacteria. Therefore, it is very important that you keep your skin clean. Bathing in warm water will help you stay fresh as well as clean. Additionally, mix some Epsom salts in water and soak yourself for about 15 minutes regularly. Colloidal oatmeal or mild oil will also serve the purpose. If you happen to develop scales, remove them using a soft cloth. Once you have had your bath, remember to apply an oil-rich moisturizer to prevent your skin from drying. And if possible, you may want to cover the affected areas of your skin with a cloth or plastic wrap applied with a moisturizer. More on Psoriasis home remedies.

Epsom salts

Health experts also recommend the use of over-the-counter medications and lotions for those who have blistery or inflamed skin. Ensure that the products you purchase contain hydrocortisone or salicylic acid.

Triggers: Pustular psoriasis, in most cases, is caused due to external triggers. If you possibly can, it is an excellent idea to keep a notebook which contains facts about the situations in which you were affected. Some very popular triggers are smoking, consumption of alcohol, prolonged exposure to the sun, stress and extreme temperature conditions. Needless to say, you must avoid these situations in future to prevent any recurrence of psoriasis.

Immune system disorders: While most people consider psoriasis to be a skin related issue, experts agree to the fact that psoriasis is actually related to problems caused in the immune system. The National Psoriasis Association also supports this belief, and it has been found that regulating your immune system will help inhibit illness as well as counter psoriasis. Healthy and balanced meals are essential, and so is regular exercise. Doctors also recommend a healthy sleep of minimum seven hours on a daily basis.


Although it has also been emphasized above, it must be notably mentioned that Von Zumbusch pustular psoriasis can be fatal. The condition typically appears all of a sudden, and it might be some time later that the patient realizes the formation of pus-filled blisters. The symptoms related to this are characterized by fever, aches, itching, dryness, weight loss and dehydration. If you notice these symptoms, it is strongly advised that you seek medical attention at the earliest.

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