Pustular psoriasis
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Pustular psoriasis is a rare and severe form of inflammatory psoriasis characterized by the presence of sterile pustules filled with neutrophils on an erythematous, swollen base. The lesions can be localized or generalized and often occur with systemic symptoms, distinguishing this condition from the more common plaque psoriasis. The disease has an immunological and genetic basis, and its course can be abrupt and recurrent. Due to the potential for systemic complications, pustular psoriasis requires rapid diagnosis and specialized treatment, often interdisciplinary. In some patients, it constitutes a separate disease entity, while in others it coexists with other forms of psoriasis.
Pustular psoriasis – causes
The pathogenesis of pustular psoriasis is complex and involves the abnormal activation of both the innate and adaptive immune response of the skin. Pro-inflammatory cytokines and disruptions in the interleukin pathways responsible for the influx of neutrophils into the epidermis play a key role.
The most important etiological and triggering factors include:
- Genetic predispositions, including mutations in genes regulating the inflammatory response of the epidermis,
- Sudden withdrawal of systemic glucocorticosteroids,
- Infections, particularly bacterial (e.g., upper respiratory tract),
- Pregnancy – a specific form of the disease may occur in the third trimester,
- Drugs affecting the immune system or calcium metabolism,
- Physical and psychological stress, injuries, metabolic disorders.
Unlike plaque psoriasis, in pustular psoriasis, inflammatory mechanisms related to excessive recruitment of neutrophils dominate, rather than solely the proliferation of keratinocytes.
Pustular psoriasis – symptoms
The clinical picture of pustular psoriasis is distinct and usually does not raise diagnostic doubts, although in the initial phase it may resemble skin infections.
Typical skin symptoms:
- numerous, small pustules with sterile content,
- pustules situated on intensely reddened and painful skin,
- tendency for lesions to merge and form extensive areas,
- after pustules burst – skin peeling and erosion.
Systemic symptoms (especially in generalized forms):
- fever,
- chills,
- weakness, feeling unwell,
- electrolyte imbalances,
- rapid heartbeat.
Skin lesions are often painful, and sometimes accompanied by burning and skin tension, which significantly reduces the patient's quality of life.
Pustular psoriasis – types
Pustular psoriasis is not a homogeneous entity and includes several distinct clinical forms:
1. Generalized pustular psoriasis
- the most severe form of the disease,
- rapid onset,
- extensive skin lesions and systemic symptoms,
- a potentially life-threatening condition.
2. Palmoplantar pustular psoriasis
- lesions limited to the palms and soles,
- recurrent course,
- pain and skin cracking that hinder walking and manual work.
3. Pustular psoriasis of pregnancy
- occurs during pregnancy,
- requires special dermatological and gynecological monitoring,
- may affect the general condition of the mother and fetus.
4. Focal pustular psoriasis
- lesions localized within single skin areas,
- often coexists with other forms of psoriasis.
Pustular psoriasis – treatment
The treatment of pustular psoriasis is always individualized and depends on the form of the disease, the extent of the lesions, and the patient's general condition. In severe cases, hospitalization may be necessary.
Main goals of therapy:
- rapid suppression of the inflammatory process,
- control of systemic symptoms,
- prevention of relapses.
Therapeutic strategies include:
- systemic treatments modulating the immune response,
- targeted therapies aimed at specific inflammatory cytokines,
- topical treatments supporting epidermal regeneration,
- phototherapy in selected stable cases.
An important element is also:
- elimination of triggering factors,
- strict dermatological monitoring,
- patient education about the recurrent nature of the disease.
Pustular psoriasis treatments
Dermatological and dermatoesthetic procedures do not constitute causal treatment for pustular psoriasis, yet they can play a significant supportive role during remission or stabilization periods of the disease.
The procedures used for patients with pustular psoriasis include:
- treatments that improve the epidermal barrier and skin hydration,
- therapies with anti-inflammatory and regenerative effects,
- procedures that support microcirculation and tissue metabolism,
- gentle physical methods used exclusively outside the active phase of the disease.
Each procedural intervention should be:
- preceded by a dermatological evaluation,
- individually tailored to the skin condition,
- performed with particular caution.
In the active phase of pustular psoriasis, aesthetic procedures are contraindicated, and the priority remains dermatological treatment based on current clinical knowledge.
