Pustular psoriasis: symptoms, causes and remedies

By Cristiano Antonino On Jan 12, 2023

Pustular psoriasis is a skin disorder that can present in heterogeneous ways and is characterised by sterile pustules

The different forms of pustular psoriasis

The known clinical phenotypes of pustular psoriasis are:

acute generalised pustular psoriasis (Von-Zumbusch’s)
impetigo herpetiformis (typical of pregnancy);
palmoplantar pustular psoriasis;
pustular psoriasis annularis;
infantile pustular psoriasis;
continuous acrodermatitis of Hallopeau.

These different forms of psoriasis have in common, from a clinical point of view, the presence of sterile pustules (i.e. not due to bacterial infection) arising on an erythematous basis.

The symptoms with which it manifests itself

Symptoms vary from

paucisymptomatic forms (few and of low intensity);
forms that endanger the patient’s general condition (in the generalised form).

From a pathogenetic point of view, pustular psoriasis is characterised by an intense inflammatory response due to an exaggerated activation of innate immunity with a main involvement of interleukin 36.

Risk factors for pustular psoriasis

Although in some cases pustular psoriasis occurs without clear triggering causes, several risk factors have been described that can promote its onset, such as:

medications;
infections;
autoimmune diseases;
excessive photo-exposure;
cigarette smoking.

Diagnosis and therapy

The diagnosis can be made on the basis of the clinical-anamnestic picture and confirmed by a histological test in the more complex forms.

Therapy of localised forms is mainly based on the use of topical corticosteroids, vitamin D derivatives and emollients, as well as phototherapy in palmo-plantar forms.

For generalised forms or localised forms that are not responsive to the aforementioned treatments, therapy has historically been based primarily on the use of systemic drugs such as:

acitretin;
cyclosporine;
methotrexate.

In recent years, however, the advent of biologic drugs (mainly anti-TNF-alpha, anti IL 12/23 and anti-IL 17) has enabled a further marked improvement in the management of this disease.

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