Psoriasis – Pustular Psoriasis

Pustular Psoriasis is a rare type of Psoriasis which I encounter  only occasionally in both my The Woodlands dermatology and Conroe dermatology clinics.  Pustular Psoriasis can occur in patients with long standing chronic Plaque Type Psoriasis who are suddenly discontinued from systemic steroids.  Around the psoriatic plaques, superficial pustules can form that may coalesce into “lakes of pus.” If Pustular Psoriasis becomes generalized it is called the Von Zumbusch variety and can have life threatening consequences.  Patients may develop sepsis as many of their neutrophils (white blood cells) have left the blood stream and are in the skin as the constituents of the pus.  Also patients may develop hypocalcemia, pneumonia, congestive heart failure, and hepatitis.  Pustular Psoriasis may also be seen localized in a patient’s normal plaques and is common in those who smoke.  Treatment of Pustular Psoriasis is with Acitretin, a systemic retinoid, and Cyclosporine can be used in severe cases.