Bacteriology of pustules occurring during treatment of psoriasis

Area of Science:

• Dermatology
• Clinical Medicine
• Microbiology

Background:

• Psoriasis treatment can sometimes lead to secondary complications.
• The modified Goeckerman regimen is a treatment for psoriasis.
• The cause of pustular lesions in psoriasis patients is not fully understood.

Purpose of the Study:

• To investigate the role of bacterial infection in pustular lesions developed during modified Goeckerman therapy for psoriasis.
• To determine the characteristics and potential causes of these pustular lesions.
• To assess the efficacy of topical antibiotic treatment for these lesions.

Main Methods:

• Psoriatic inpatients treated with a modified Goeckerman regimen were monitored for pustular lesions.
• Lesions were cultured and organisms quantitated to assess bacterial involvement.
• Patient factors such as hirsutism, hyperhidrosis, and topical occlusive treatments were noted.
• Clinical observations on lesion resolution with and without topical antibiotic therapy were recorded.

Main Results:

• Pustular lesions occurred in 16% of patients.
• Bacterial cultures from lesions did not yield a significant number of organisms.
• Lesions were more common in summer, in hirsute patients, those with hyperhidrosis, and with occlusive topical treatments.
• The male-to-female ratio was 4.8:1.
• Lesions resolved upon discontinuation of topical therapy, suggesting antibiotics were unwarranted.

Conclusions:

• Bacterial infection is unlikely to be the cause of pustular lesions in psoriatic patients treated with the modified Goeckerman regimen.
• These pustules appear to be a distinct clinical entity, separate from pustular psoriasis.
• Management should focus on discontinuing occlusive topical therapies rather than antibiotic treatment.