Treating Psoriasis

Pustular psoriasis appears most often in adults. Outbreaks are evidenced by white pustules or blisters holding non-infectious pus, surrounded by skin that’s turned red. The condition is not contagious. Contrary to what appears on the surface, pustular psoriasis is not an infection, even though the pus is composed of white blood cells.

Pustular psoriasis can appear on most areas of the body, but typically is confined to the hands and feet. A flare-up will often begin with reddening of the skin, after which the pustules occur along with the scaling so often associated with psoriasis.

A Number of Reasons Why it Occurs

Frequently, pustular psoriasis starts after taking certain internal medications. It also can result from the irritation of topical medications. Other triggers are overexposure to ultra-violet light, pregnancy or even systemic steroids, infections, emotional stress as well as sudden withdrawal of systemic medications and from topical steroids of a potent kind.

Since side effects can potentially stem from systemic medications and phototherapy, doctors often combine or shift treatments for pustular psoriasis. And, according to many studies, Soriatane and methotrexate together can produce quick remission in acute pustular psoriasis and a consequent clearing of the skin.

The different kinds of pustular psoriasis include von Zumbusch, palmo-plantar pustulosis, and also acropustulosis. Von Zumbusch pustular psoriasis can begin abruptly and there is a widespread area of red skin which causes pain as well as tenderness in the skin.

Rarely is pustular psoriasis seen in children, although childhood outbreaks are not unknown. The triggers that bring about von Zumbusch pustular psoriasis include infections, sudden withdrawal of topical or systemic steroids, pregnancy as well as drugs of the likes of lithium, propranolol as well as other high blood pressure drugs.

The other kind of pustular psoriasis is called palmo-plantar pustulosis which causes pustules on the palms or the hands and soles of the feet and is characterized by multiple pencil eraser-sized pustules in the fleshy parts of the hands and feet including the thumb and sides of the heels.

Stopping smoking is highly recommended when one is susceptible to this form of pustular psoriasis. Nicotine has been shown to trigger episodes of palmo-plantar pustulosis. It can be treated with topical treatments though it may be stubborn to treat, but PUVA, UVB, Soriatane, methotrexate or cyclosporine are used to clear it.

An even more rare type of pustular psoriasis is acropustulosis in which skin lesions erupt on the ends of the fingers as well as, in a few instances, on the toes. Eruptions can begin suddenly after sustaining an injury to the skin or from infection. In these cases, the lesions will cause pain and be disabling leading to a deformity of the nails.

In severe cases, which are few and far between, bone changes can also occur and such instances are hard to treat. Patient’s topical preparations that are occluded will be helpful and systemic medications are also tried out with success in clearing of the lesions as well as to restore the nails.