Pustular psoriasis



What is pustular psoriasis?

Psoriasis is a skin condition that causes red, scaly skin patches. It can occur anywhere on the body, but it’s often found around the knees and elbows.

Psoriasis is not contagious, and it can actually appear in different forms. One of these forms is pustular psoriasis, which causes white, noninfectious pus-filled blisters (pustules).

Pustular psoriasis can happen in conjunction with other forms of psoriasis, such as plaque psoriasis. It can break out in single areas, such as the hands and feet, or all over your body. But it is rarely seen on the face. It usually begins with an area of skin becoming tender and red. Within a few hours, the telltale large blisters of noninfectious pus form. Eventually, these blisters turn brown and crusty. After they peel off, skin can appear shiny or scaly.

Types of pustular psoriasis

  • Von Zumbusch pustular psoriasis
  • Palmoplantar pustulosi
  • Acropustulosis

How common is pustular psoriasis?

Anyone can get psoriasis, but the average age of adults who get it is 50 years old. It’s rare for children under the age of 10 to get this condition.

Please discuss with your doctor for further information.


What are the symptoms of pustular psoriasis?

Von Zumbusch pustular psoriasis

Von Zumbusch psoriasis (acute generalized pustular psoriasis) begins with painful areas of red skin. Pustules form within hours and dry up in a day or two. Von Zumbusch can recur in cycles, returning every few days or weeks. Von Zumbusch is rare in children, but when it does occur the outcome is better than when it appears in adults. In children, the condition often improves without treatment.

Symptoms include:

  • Severe itching
  • Fever
  • Rapid pulse rate
  • Muscle weakness
  • Anemia
  • Chills
  • Dehydration

Immediate medical care is necessary for this condition. Over time von Zumbusch can cause weight loss and exhaustion. Potential complications include hair and nail loss, secondary bacterial infection, and liver damage. If left untreated, it can lead to cardiorespiratory failure.

Palmoplantar pustulosi

Palmoplantar pustulosis (PPP) is a type of pustular psoriasis that forms on the palms of your hands (usually at the base of your thumb), as well as on the soles of your feet and the sides of your heels. These pustules begin on top of red patches of skin and later turn brown, peel off, and form a crust.

As with von Zumbusch, PPP can come and go in cycles, leaving the skin with a rough, cracked appearance. Smokers have a higher incidence of PPP than nonsmokers.


Acropustulosis is a rare form of pustular psoriasis. It’s clearly identifiable by painful skin lesions that form on the ends of fingers and toes. When the pustules burst, they leave bright red scaly patches that can ooze. This type of psoriasis is usually the result of an infection or injury to the skin. It can become severe enough to cause toenail deformities and physical changes to the bone and finger.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.


What causes pustular psoriasis?

To understand pustular psoriasis, one must recognize aspects of classical plaque-type psoriasis. It is generally agreed that a combination of genetics and environment induce psoriasis, including this pustular subtype.

Risk factors

What increases my risk for pustular psoriasis?

Pustular psoriasis can be triggered by a variety of factors, including:

Certain drugs may also cause pustular psoriasis. These drugs include internal medications, systemic steroids, and topical medications. It can also be caused by rapid withdrawal from strong topical steroids or systemic medications.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is pustular psoriasis diagnosed?

Pustular psoriasis is not a typical skin rash. Visit a doctor if you notice unusual skin changes or if you have a rash, blister, or open sore that does not improve or worsens.

To diagnose pustular psoriasis, your doctor may perform a complete blood count to check for signs of abnormalities with your white blood cells and signs of elevated inflammation. Your blood work may show reduced lymphocytes, a type of white blood cell, if you have pustular psoriasis. Sometimes, doctors will remove and examine a sample of the pustule to diagnose the condition.

How is pustular psoriasis treated?

Your treatment will depend on the type of psoriasis you have and how serious it is. Sometimes it takes several approaches or a combination of treatments to find the most effective approach. Your doctor will probably prescribe topical skin ointments first because they can soothe your skin and reduce inflammation. Ultraviolet light, both natural and artificial, is used to treat psoriasis. PUVA treatment is a combination of UV light and a medication that makes your skin more sensitive to it.

Your doctor may prescribe medications such as:

  • Acitretin
  • Cyclosporine
  • Methotrexate
  • Oral psoralen plus ultraviolet A light
  • TNF-alpha blockers, or infliximab

Generalized pustular psoriasis also requires measures to prevent dehydration and infection.

Specific treatment for each type of pustular psoriasis:

Von Zumbusch pustular psoriasis

Treatment may include antibiotics, rehydration, and topical creams. If these don’t work, your doctor may prescribe an oral steroid to relieve symptoms. Sudden withdrawal of oral steroids can cause reoccurrence of von Zumbusch psoriasis. You’ll have to slowly wean yourself off this medication with a doctor’s supervision. Talk to your doctor about the risks of oral steroids to fully understand the effects.

Palmoplantar pustulosi

To treat palmoplantar pustulosi, you may need a combination of different treatments, such as a topical treatment, ultraviolet radiation treatment, or an immune system suppressant like methotrexate. Talk to your doctor about your treatment options for PPP.


There is little evidence of what effectively treats acropustulosis. This condition is very rare and likely requires a combination of topical ointments and medications.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage pustular psoriasis?

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: November 2, 2017 | Last Modified: November 3, 2017

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