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A brief guide to pustular psoriasis for primary care providers
Jeffrey J Crowley1, David M Pariser2, Paul S Yamauchi3
1Bakersfield Dermatology & Skin Cancer Medical Group, Bakersfield, CA, USA.
Postgraduate Medicine
|October 29, 2020
Summary
Pustular psoriasis encompasses distinct inflammatory skin conditions like generalized pustular psoriasis (GPP) and palmoplantar pustulosis (PPP). These rare but severe diseases require careful diagnosis and management, avoiding systemic corticosteroids.
Area of Science:
- Dermatology
- Immunology
- Genetics
Background:
- Pustular psoriasis is a group of chronic inflammatory skin disorders distinct from plaque psoriasis.
- It includes generalized pustular psoriasis (GPP), palmoplantar pustulosis (PPP), and acrodermatitis continua of Hallopeau (ACH).
- These conditions, though rare, can be severe and have significant health consequences.
Purpose of the Study:
- To differentiate pustular psoriasis subtypes from plaque psoriasis.
- To highlight the clinical presentations and potential severity of GPP, PPP, and ACH.
- To emphasize diagnostic challenges and appropriate management strategies, particularly regarding corticosteroid use.
Main Methods:
- Clinical and histological differentiation of pustular psoriasis subtypes.
- Genetic analysis to distinguish from plaque psoriasis.
- Review of disease severity, complications, and treatment implications.
Main Results:
- Pustular psoriasis presents as GPP (systemic), PPP (localized palm/sole), or ACH (digits/nails).
- GPP flares can be medical emergencies with life-threatening complications.
- PPP and ACH are debilitating, causing impaired quality of life and irreversible damage.
Conclusions:
- Pustular psoriasis subtypes are clinically, histologically, and genetically distinct from plaque psoriasis.
- Early diagnosis and dermatological consultation are crucial for managing these rare but severe conditions.
- Systemic corticosteroids should be avoided in all forms of pustular psoriasis due to the risk of triggering flares.
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