What is Pustular Psoriasis?
From all the existent psoriasis types out there, pustular psoriasis is one of the rarest and most uncommon. A short description of pustular psoriasis would be: the skin of the affected patient presents small bumps and these are filled with a white and thick liquid. This liquid is actually composed of white blood cells and it is non-infectious. According to the studies made on this disease so far there has been no evidence that infectious factors play any role.
Pustular psoriasis is present in every race and there is no gender difference when it comes to the number of patients affected. In children however, the number of boys who get pustular psoriasis is slightly higher than the number of girls. The average age for this disease is fifty years and in very rare cases it can be detected in small children.
What does pustular psoriasis look like?
Depending on the type of pustular psoriasis, the disease is going to look different.
- Von Zumbusch – in this situation, the skin initially presents extensive areas of redness. Not long after these areas become painful and tender, the pustules will appear. After these heal, the skin will have a smooth appearance.
- Palmoplantar pustulosis – in this situation, the pustules appear on the palm of the hand and the sole of the foot. Pustules tend to turn brown, peel and then they transform into crusts.
- Acropustulosis – in this situation, the skin lesions appear at the end of the finger and toe.
These are the most common symptoms of pustular psoriasis:
- Widespread areas of redness on the skin, sometimes plaques
- Pustules filled with thick, white, non-infectious liquid. The most common areas are the genital and anal area but also where the skin rubs
- More rarely, pustules can appear on the face or on the tongue. In the latter case, patients can have difficulty swallowing.
- Pustules can appear under the nail, causing it to come off
- Skin inflammation
- Secondary skin infection
- Skin is painful and tender to touch
- Before the appearance of the pustules, you may experience any of the following symptoms:
- Joint pain
- General discomfort
- Lack of appetite
- Hair loss
- Ring-shaped plaques, with pustules at the edge of the ring – in small children
- Bone or joint inflammation – chronic pustular psoriasis (palmoplantar pustulosis, with white or yellow pustules on a reddish palm or sole)
- Skin around the pustules is thick and flaky, presenting an increased risk for cracks
- Pustules can become joined, forming a lake of pus
- After the pustules dry out and peel, the skin is smooth to the surface
- New crops of pustules may appear on the smooth skin
These are the main causes of pustular psoriasis:
- Messenger protein abnormalities (recessive gene mutation)
- Preceding history of psoriasis with identified gene abnormalities (10% of patients)
- Powerful topical medication
- Topical corticosteroids withdrawal
- Cholestatic jaundice
- Low levels of calcium in the blood
- Thyroid dysfunctions
- Celiac disease
These are the main trigger factors of pustular psoriasis:
- Sudden withdrawal of corticosteroids
- Medication – anti-inflammatory drugs such as aspirin, beta blockers, oral iodides, antibiotics (penicillin), Calcipotriol (synthetic vitamin D derivative)
- Excessive sun exposure
- Emotional stress
These are the most common tests and investigations that contribute to the making of the diagnosis for pustular psoriasis:
- Complete blood count – revealing reduced number of lymphocytes (white blood cells) and an increased number of leukocytes. Plus, inflammation will be observed if the erythrocyte sedimentation rate is increased as well. Decreased levels of zinc and calcium in the blood can also be identified
- Sample of pustule content (culture) – the result will reveal no sign of infection, as this is an autoimmune disorder.
- Additional laboratory tests can determine the presence of bacterial infection
- Clinical assessment of the lesions
- Skin biopsy – this is different from the sample taken from the pustules and it reveals neutrophilic infiltration
Kidney and liver investigations, to determine whether they function correctly or not
These are the most common courses of treatment for pustular psoriasis:
- Hospital admission is required in case of patients who need to be properly hydrated and who also need bed rest. This disease can put a lot of effort on the heart, so close medical supervision is more than necessary. This is valid for the general form of pustular psoriasis, that can be life-threatening. Body temperature needs to be stabilized as well.
- Wet compresses bring calm to the painful and tender areas.
- Saline solutions and oatmeal baths.
- Topical therapy:
- Corticosteroids – these have to be used only under medical supervision as they have powerful side-effects and the sudden withdrawal can lead to the appearance of new pustules on its own.
- Vitamin D3 derivatives.
- Coal tar.
- Retinoids – these have to be used only for a limited period of time, as they can have serious side-effects.
- Ultraviolet therapy – UV-B spectrum is preferred for pustular psoriasis.
- Oral retinoids – these are recommended for the general pustular psoriasis, especially when the disease has just appeared. The same precautions as with topical retinoids apply.
- Phototherapy – this has to be applied with care as well, as it can lead to the appearance of new pustules.
- Antibiotics are recommended in cases of confirmed infection in the body.
- Ciclosporin – immunosuppressant drug.
- Methotrexate – antimetabolite and antifolate drug.
- Biologic agents – Infliximab, chimeric monoclonal antibody.
- Antibacterial soap will protect you against secondary infections.
These are a few recommendations for natural remedies that might alleviate the symptoms of pustular psoriasis:
- Tree bark extract
- Oatmeal – bathing in oatmeal can help with the symptoms, as it was already mentioned.
- Saline water – same purpose as above.
- Applying oil-rich, natural moisturizer after a warm bath.
- Sea Buckthorn Oil – contains fatty acids that can regulate inflammatory and immune responses.
- Neem Leaf Oil – prevents the skin from cracking and it also has anti-bacterial properties.
- Emu Oil – it has anti-inflammatory properties and it can calm the reddish skin.
- Apple Cider Vinegar – reduces the inflammation.
- Organic chamomile tea – calming properties.
- Salve, rosemary and lavender oil – perfect to apply on the affected areas.
- Jojoba oil – soothes the inflamed skin.
- Fish oil supplements
- Green tea – antioxidant properties.
- Turmeric – a spice with anti-inflammatory properties.
Is pustular psoriasis contagious?
Even though the main feature of pustular psoriasis is represented by the pustules filled with white liquid, it is important to understand that liquid is not infectious. As any pustule culture will show, the liquid does not contain infectious agents. And if a disease is not infectious, then it is not contagious.