Pustular Psoriasis

Excerpt

Pustular psoriasis is a rare, immune-mediated systemic skin disorder characterized by yellowish pustules on an erythematous base with a variety of clinical presentations and distribution patterns. Pustular psoriasis is considered a variant of psoriasis vulgaris. The pustules can be widespread or localized and are characterized by a sterile predominantly neutrophilic infiltrate. Unlike chronic plaque psoriasis (the most common variant of psoriasis vulgaris), lesions of pustular psoriasis are often tender to palpation. Pustular psoriasis can be further subdivided based on the clinical presentation and the location of pustules.

Subtypes of pustular psoriasis include:

1. Generalized:

   1. von Zumbusch subtype: Diffuse generalized pustular eruption with associated systemic symptoms (fevers, arthralgias, etc.)

   2. Annular subtype: Annular lesions with pustules along the advancing edge.

   3. Exanthematic subtype: Acute pustular eruption without systemic symptoms that resolves after a few days.

   4. Impetigo herpetiformis: Pustular psoriasis occurring during pregnancy.

2. Localized:

   1. Acrodermatitis continua of Hallopeau: Pustules affecting the fingers, toes, and nail beds.

   2. Palmoplantar psoriasis: Pustules affecting the palms and soles