pustular psoriasis 14

What is Pustular Psoriasis?

Pustular psoriasis is a rare and severe form of psoriasis that involves widespread inflammation of the skin. It appears as small white or yellow pus-filled bumps (called pustules) on the skin, often accompanied by redness and swelling.

According to various sources [2][3], this condition can manifest in different ways, including:

• Generalized Pustular Psoriasis (GPP): A rare and severe form of psoriasis that presents with a sudden onset of rash and pustules located on nonacral areas of the body.
• Localized Pustular Psoriasis: A milder form of the condition, where pustules are limited to specific areas of the skin.

The symptoms of pustular psoriasis can vary in severity and may include:

• Pus-filled bumps (pustules): White or yellow bumps filled with pus that can be painful and tender to the touch.
• Redness and swelling: The affected skin area may become red, swollen, and inflamed.
• Fever and chills: Some people may experience fever and chills as a result of the infection.

It's essential to seek medical attention if you suspect you have pustular psoriasis, as it can be a sign of an underlying condition that requires proper treatment.

Common Signs and Symptoms of Pustular Psoriasis

Pustular psoriasis is a rare and severe form of psoriasis that can cause significant discomfort and distress. The symptoms of this condition can vary from person to person, but here are some common signs and symptoms:

• White or yellow bumps filled with pus: These bumps, also known as pustules, are a hallmark symptom of pustular psoriasis [2].
• Pain: Pustular psoriasis can be painful, especially if the skin is cracked or broken [8].
• Fever: Some people may experience fever, chills, and other flu-like symptoms when they have pustular psoriasis [3], [5].
• Rapid pulse: A rapid heart rate can also occur in some cases of pustular psoriasis [5].
• Dehydration: In severe cases, pustular psoriasis can lead to dehydration due to excessive sweating and skin lesions [5].

It's essential to note that these symptoms can vary in severity and may come and go in cycles. If you're experiencing any of these symptoms, it's crucial to consult a healthcare professional for proper diagnosis and treatment.

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Diagnostic Tests for Pustular Psoriasis

Pustular psoriasis can be diagnosed through a combination of clinical evaluation, laboratory tests, and histopathological examination.

• Clinical Evaluation: A dermatologist will examine the skin to look for characteristic symptoms such as pustules, erythema (redness), and scaling. The presence of these symptoms, particularly in areas like the palms and soles, can help confirm a diagnosis of palmoplantar pustular psoriasis [5].
• Laboratory Tests: Blood tests may be ordered to rule out other conditions that may cause similar symptoms. These tests include:
  • Erythrocyte sedimentation rate (ESR) [8]
  • C-reactive protein (CRP) [8]
  • Urea
  • Creatinine
  • Liver enzymes (AST, ALT)
• Histopathological Examination: A skin biopsy may be performed to confirm the diagnosis. The biopsy involves taking a small sample of affected skin and examining it under a microscope for characteristic features such as:
  • Basal cell hyperplasia [6]
  • Proliferation of keratinocytes
  • Presence of Kogoj's spongiform pustules [7]

It is worth noting that while these tests can help confirm a diagnosis, they are not always necessary. In some cases, the clinical evaluation and medical history may be sufficient to make a diagnosis.

References: [5] - Pustular psoriasis causes noninfectious pus-filled blisters. Learn about different types like palmoplantar pustular psoriasis, symptoms, ... [6] - In these cases, dermatologic biopsy can be used to make diagnosis. Biopsy of the skin lesion may reveal basal cell hyperplasia, proliferation of ... [7] - The presence of Kogoj's spongiform pustules is a characteristic feature of GPP and can be confirmed by histopathological examination. [8] - How is generalised pustular psoriasis diagnosed? · Erythrocyte sedimentation rate (ESR) · C-reactive protein (CRP) · Urea · Creatinine · Liver enzymes (AST, ALT) ...

Treatment Options for Pustular Psoriasis

Pustular psoriasis can be effectively managed with various treatment options, including drug therapies. Here are some of the most commonly used medications:

• Oral Retinoids: Acitretin and isotretinoin are two types of oral retinoids that have been shown to be effective in treating pustular psoriasis [9][10]. These medications work by slowing down skin cell growth and reducing inflammation.
• Cyclosporine: This immunosuppressive medication can help calm down the immune system and reduce symptoms of pustular psoriasis [6][7].
• Methotrexate: Another oral medication, methotrexate, has been found to be effective in treating pustular psoriasis by reducing inflammation and slowing down skin cell growth [6][9].
• Infliximab: This biologic medication can help reduce symptoms of pustular psoriasis by targeting specific proteins involved in the immune response [5][10].

Other Treatment Options

In addition to these medications, other treatment options for pustular psoriasis include:

• Topicals: Corticosteroids and non-steroidal drugs can be applied topically to reduce inflammation and itching [3].
• Phototherapy: Exposure to specific wavelengths of light can help slow down skin cell growth and reduce symptoms of pustular psoriasis [1].

Newly Approved Treatment

Recently, the US Food and Drug Administration has approved SPEVIGO as a treatment option for generalized pustular psoriasis (GPP) flares in adults [4]. This approval provides new hope for patients with this condition.

References:

[1] Context 1: PUVA therapy involves taking a medication called psoralen before getting light treatment known as UVA therapy. [3] Context 3: Topicals including corticosteroids and non-steroidal drugs ; Phototherapy (or light therapy) ; Oral treatments such as acitretin and cyclosporine. [4] Context 4: The US Food and Drug Administration has approved SPEVIGO, the first approved treatment option for generalized pustular psoriasis (GPP) flares in adults. [5] Context 5: Retinoids, cyclosporine, and methotrexate are the most commonly used non-biologic therapies for GPP. The evidence that supports the currently available ... [6] Context 6: Oral drugs such as cyclosporine or methotrexate may help calm down your immune system. Acitretin (Soriatane) is another drug that can slow skin ... [7] Context 7: Severe and extensive disease is likely to most effectively be treated with infliximab or cyclosporine, given the quicker onset of action with these drugs. [9] Context 9: Jul 1, 2024 — Oral retinoids (acitretin, isotretinoin), methotrexate, cyclosporine, and infliximab are considered first-line therapies for pustular psoriasis. [10] Context 10: by A Robinson · 2012 · Cited by 326 — Acitretin, cyclosporine, methotrexate, and infliximab are considered to be first-line therapies for patients with generalized pustular psoriasis. Adalimumab, ...

Differential Diagnosis of Pustular Psoriasis

Pustular psoriasis can be challenging to diagnose, as it shares similar symptoms with other skin conditions. The differential diagnosis for pustular psoriasis includes:

• IgA pemphigus: A rare autoimmune disorder that causes blistering and pustules on the skin [1].
• Subcorneal pustular dermatosis (SPD): A condition characterized by sterile pustules on the skin, often accompanied by fever and malaise [2].
• Palmoplantar pustular psoriasis (PPP): A localized form of pustular psoriasis that affects the palms and soles [3].
• Acrodermatitis continua of Hallopeau: A rare condition characterized by inflammation and pustules on the skin, often accompanied by fever and malaise [4].

According to the Japanese guidelines, Generalized Pustular Psoriasis (GPP) is diagnosed based on the repeated recurrence of systemic symptoms, such as fever and fatigue, in addition to skin manifestations [5]. Other differential diagnoses for GPP include localized forms of pustular psoriasis, IgA pemphigus, and subcorneal pustular dermatosis [6].

It's essential to carefully assess a patient's skin symptoms and potential underlying conditions to distinguish GPP from other similar conditions [7]. A thorough evaluation by a healthcare professional is necessary for an accurate diagnosis.

References: [1] Context 1 [2] Context 2 [3] Context 2 [4] Context 2 [5] Context 4 [6] Context 9 [7] Context 8