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Assessment of acute pustular psoriasis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Assessment of acute pustular psoriasis:

  • clinical assessment
    • 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.

Reference:


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