pustular psoriasis appears as numerous discrete and confluent superficial, yellowish pustules on a background of erythema
can be diffuse or localized
a full body skin examination should be performed, including careful evaluation of the mucous membranes and the nails for signs of psoriasis and to exclude other causes of pustulosis
pustular psoriasis starts as red papules or plaques that quickly evolves into yellowish, superficial pustules on a background of erythema
generalized psoriasis
generalized von Zumbusch subtype usually presents with systemic symptoms like fever, joint pain, headaches, and leukocytosis
in contrast, the exanthematic subtype presents as an acute pustular eruption without systemic symptoms
annular subtype is seen more frequently in children as annular lesions with pustules along the advancing edge
localized pustular psoriasis
acrodermatitis continua of Hallopeau affects the finger, toes, and nailbeds
palmoplantar psoriasis, which can be seen as part of SAPHO (Synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome, affects the palms and soles
clinician should inquire about the trigger factors in patients who present with pustular psoriasis, especially the use of medications like corticosteroids. Family history is important to ascertain since there is a genetic element responsible for the disease
laboratory assessment:
patients with suspected pustular psoriasis require careful evaluation, as the von Zumbusch subtype can be life-threatening
laboratory tests include:
FBC, U+Es, bone profile, LFTs
to assess leukocytosis, electrolyte balance, hypocalcemia, transaminases and albumin
a pregnancy test should be ordered in women of childbearing age
a punch biopsy can be performed in all equivocal cases.
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