PUSTULAR PSORIASIS – TYPES, SYMPTOMS, AND TREATMENT

• Psoriasis is an autoimmune skin condition that leads to inflammation in different areas of the body. It causes the rapid growth of skin cells those results in skin changes.
• Pustular psoriasis is a form of psoriasis that is rare and severe form. It involves inflammation of the skin and small white or yellow pus-filled blisters or pustules.
• In pustular psoriasis, pus contains white blood cells and there is not any kind of infection. Pustular psoriasis is not contagious.
• The affected areas will appear red or dark patches form on skin. 
• Among all type of pustular psoriasis, generalized pustular psoriasis (GPP), leads to widespread symptoms across the body.
• Other types of pustular psoriasis include palmoplantar pustulosis and acrodermatitis that affect only the hands and feet.

Causative factors for Pustular psoriasis

• Exact reason of pustular psoriasis is not known yet but   specific genetic features might increase a risk of developing the condition. 
• Hereditary factors also play role in causing pustular psoriasis and so this condition runs in families.

Risk factors

Risk factors can trigger the condition. These may include

• Use of or withdrawal from certain internal medications like corticosteroids
• Topical use of some creams
• Overexposure to UV light, for example, sunlight
• Some infections
• Stress

Symptoms and types

• Pustular psoriasis involves widespread areas of inflamed skin and pustules that contain fluid, or pus and it can be painful condition.
• Pustules may appear brown or crusty on drying. The skin around the pustules may become thick and flaky and the skin may crack.

Generalized Pustular psoriasis

• In Generalized pustular psoriasis, the skin will become hot and tender. After few hours, pustules appear, around 2–3 millimeters in diameter. Then after 24 hrs, the pustules will start to join together so that pools of pus form.
• The areas of pus dry out after some time, leaving a smooth, shiny surface. New pustules remain to form in every few days.
• Symptom will resolve with treatment.
• Some people develop erythroderma, a serious condition that may need emergency medical attention.

Symptoms may include:

• Formation of Pustules
• Inflamed skin that is red on light skin or darker in black skin
• Peeling of skin all over the body
• Fever and shivering 
• Itching
• A rapid pulse
• Dehydration and exhaustion
• Headache & nausea
• Muscle weakness and joint pain
• Anemia
• Weight loss

The skin may become very sore and fragile. After some time , milder flares of skin may occur. Following symptoms are also noticed among people.

• Cholangitis
• Furrowed or geographic tongue
• Unusual nail growth or poor nail formation

Palmoplantar pustulosis

• Large, yellow colored pustules seen in the fleshy areas of the hands and feet.
• Depending on the severity of condition ,  some people faces challenges in normal works  such as walking etc.
• According to the Psoriasis and Psoriatic Arthritis Alliance (PAPAA), around 5% of people with psoriasis will experience palmoplantar pustulosis.

According to PAPAA, it commonly affect people who:

• Are aged 20–60 years
• Smoke
• Have had any kind of infection 
• Have stress

Acrodermatitis continua of Hallopeau

This is rare type of pustular psoriasis in which painful skin lesions occurs on the ends of the fingers and sometimes the toes. The lesions develop after an injury at that area. Bone changes may also noticed in people.

Pustular psoriasis of pregnancy

A rare type of pustular psoriasis — impetigo herpetiformis – can affect the females in pregnancy. This may happen because of hormonal changes that can affect the immune system. This type of psoriasis usually resolve after pregnancy.

Diagnosis of pustular psoriasis

Pustular psoriasis can be diagnosed by the type of lesions that appear on the skin, but some investigations can also confirm the diagnosis and identify possible complications.

A doctor may recommend:

• Laboratory tests to rule out a bacterial infection
• Skin biopsy
• Blood investigations
• Kidney and liver function tests
• Levels of electrolytes and minerals

Treatment options

Treatment depends upon severity of the symptoms. Line of   treatment may vary from person to person depending on their type and symptoms. A doctor may prescribe:

Topical treatment

Topical treatment is effective and can be used either alone or combined with other options. These may include:

• Compresses containing suitable topical therapies
• Corticosteroids for local applications to the skin
• Over-the-counter (OTC) topical creams that contains salicylic acid or hydrocortisone are also used in some people
• Other options include light therapy or oral medications.

Medications for GPP include:

• Antibiotics to treat infection
• Acitretin
• Systemic corticosteroids
• Biologic medications

Biologic therapy

• Biologic therapy is used to treat frequent flares or moderate to severe symptoms.
• It can be used as an injection or an infusion. Some types can be used at home also.
• Biologics can help to treat the underlying condition that leads to skin symptoms by targeting specific genes that affect how the immune system works.

Natural remedies in pustular psoriasis.

Pustular psoriasis can be treated with medical treatment, but some home remedies may help to relieve the symptoms like irritation and itching.

Options may include:

• Taking bath with salt water 
• Taking oatmeal baths
• Using an oil-rich moisturizer to keep skin moist and prevent dryness and thus peeling of skin.
• Skin care is very essential in any kind of skin condition because blistering increases the risk that bacteria will enter the skin. Keeping the skin clean and moisturized will reduce the risk of infection.

Prevention and outlook

As Psoriasis is a long-term autoimmune condition that affects the immune system. With the use of appropriate treatment and lifestyle options one can reduce the risk and severity of symptoms.

Some lifestyle choices may reduce the risk of pustular psoriasis occurring. These options may include

• Avoid smoking
• Avoid drinking 
• Remain stress-free
• Take enough sleep
• Follow healthy diet plan
• Do exercise