Pustular psoriasis is a rare type of psoriasis disease, which affects the entire body with eruptions with blisters containing pus, which are either clear or yellow pustular liquid. The skin of the affected area appears red, swollen and tender, which is filled with pustular fluid. The redness of the skin is due to the inflammation caused by its eruptions. Initially it may look like normal psoriasis but gradually it converts to pustular psoriasis. Moreover, at alter period of pustular psoriasis it may appear like a common psoriasis. Since the pustular psoriasis is thick, scaly it does not break open in its own and therefore the base of the pustule appears reddened. With the length of the disease, it can be ascertained if it is an acute or chronic pustular psoriasis. However, the major concern of the patient becomes delicate when it affects the entire body, because, the temperature and the fluid get imbalanced.
The symptom that experienced by the patient is painful skin along with itching sensation and red skin surrounding the swelling. The pustular psoriasis normally affects the area of arms, legs and the trunk of human body. However, if the entire body is affected then it is an acute or chronic form of disease. Apart from the external symptoms, the patient has fever combined with toxic reaction of tissues, like the Zumbusch type.
Different types of pustular psoriasis observed to affect people. One is the general pustular psoriasis as discussed above and others are Von Zumbusch, palmoplantar pustulosis, annular pustular psoriasis and Acropustulosis. The Zumbusch pustular psoriasis appears abruptly, and causes toxic reaction in the body. The Palmoplantar pustulosis generally appear in hands and feet. The annular pustular psoriasis initially looks like general pustular psoriasis but gradually spreads to form enlarged ring-shaped eruption on the skin. The palmoplantar pustulosis is identified easily, as it appears in the palm of the hands and soles of the feet. This type of psoriasis is rare and ten people in a million are affected with such disease. This disease affects adults, men, women and children. However, in most cases the infliction of this disease appear at the age of 50 and onwards, who are little more aged than normal patients are.
Pustular psoriasis and its causes
The causes for pustular psoriasis can be various. The cause is over-dose of medicines involving steroids, which is discontinued suddenly. Similarly, several other drugs, which acts as a medium for pustule psoriasis eruptions are iodine based creams, gels, ointments, etc, lithium, trazodone, salicylates like aspirin, anti-inflammatory drugs, anti-malaria drugs and even calcipotriol, which is administered upon psoriasis patients. Moreover, coaltar, anthralin, occlusive steroids that increases the penetration and shampoo with zinc base, causes pustular psoriasis. The person suffering from liver jaundice or undergone phototherapy, lower level of calcium in blood and chemotherapy causes pustular psoriasis.
Injury in the skin, which remains untreated for a long time, is also the cause for pustular psoriasis. When the skin is injured, T cells are produced by the immune system of the body and the white blood cell corpuscle automatically repairs the injury. If, not treated properly the immune system may T cells may fail to help in the repair of the injury.
During pregnancy, the woman is susceptible to pustular psoriasis. The reason is that during such situation a woman undergoes several complex changes inside her system. Change in the hormones and other body chemicals change when the baby is in the womb. Since the baby is a part of the woman and grows with the system provided reactions, confusion and malfunction in the immune system may arise. Hence, it is prudent to be careful and take preventive measures.
Another instance that causes pustular psoriasis is the sun radiation. This results in several disorders of the skin, giving rise to pustular psoriasis as well as skin cancer. The radiation affects and changes the behavior of T cells leading to a non-cancerous line of attack. The system in process results in confusion and attacks the epidermis and other inner layers. Therefore, it is prudent to use sun-protecting devices, when expose to longer period, if you are prone to sun radiation.
Pustular psoriasis can occur due to lingering stress. Stress is unavoidable in the contemporary society. Stress creates several types of disorders. It happens because the immune system is unable to understand the body reaction due to the anxiety, exhaustion and pain caused by stress. The immune system responds to the injury of the body and cannot detect in such cases. This can be another reason when in a confused state, the body chemistry may tend to attack the skin thereby causing pustular psoriasis.
Treatment for pustular psoriasis
The severity of the case of pustular psoriasis will decide upon its medication. Hospitalization is better because you will be under observation of specialists and your body fluid content and experts will monitor maintenance of body temperature. This type of psoriasis can lead to critical heart problems and therefore requires constant monitoring by qualified physicians or his/ assistants. You may need to undergo salt-water bath, oatmeal baths and other necessary treatment that with heal the disease and not allow its aggravation to the secondary layer.
Ointments, gels, cream solutions can be applied to the pustular psoriasis affected areas. These balms contain coal tar, corticosteroids, vitamin D3 analogues, anthralin and vitamin A derivatives. Most doctors interchange the use of such topical medicines to get better and quicker healing results. It is observed that topical medicines blended with anathralin and salicyclic acid has proven to be a healing agent. The salicyclic acid inactivates topical ointments contains Vitamin D3 and thus is beneficial for treatment.
Phototherapy or light therapy is effective in treating pustular psoriasis. The light from the sun, VB lamps or UVA lamps is used. UVA light therapy is advisable as it is mild in nature and psoralens have a major use in the PUVA treatment for this disease. Light therapy my show certain side effects such as burning of the skin.
The inflammation seen in pustular psoriasis is reduced through the complete systemic therapy in the form of retinoids or biologics like Enbrel & Humira work. Systemic therapy as well as light therapy is combined together for better and quick results. Systemic therapy is used in the form of injection in every couple of weeks.
Treatment of von Zumbusch pustulosis
National Psoriasis Foundation has derived that pustules psoriasis are of three types. Von Zumbusch psoriasis is categorized under general pustular psoriasis (GPP). The symptoms and visual that are found in such psoriasis are; pain, reddening of skin at large and after few hours’ eruption and formation of pustules takes place. These pustules will dry down in a couple of days and peel off from the skin. This reaction leads to disorder in the protective function of the skins immune system, which can be potentially dangerous. The disorder in skin protection and malfunction of immune system can give rise to dehydration, higher pulse rate, fever, chills, extreme itching, tiredness, anemia, weight loss and muscle weakness.
When a person experience such symptoms, it is prudent to consult a specialist at the earliest and seek medical attention. After the preliminary diagnosis, the first step, which the doctor normally adhere to, is to restore back the normal function of the skin and repair the skins immune system. To prevent infection he administers antibiotic drugs; he may advice for hospitalization, depending on the severity, to protect the body from further dehydration. When the body is found to be stable, after the preliminary treatment, the doctor will prescribe the suitable drug from several available drugs that will be compatible to your body and at the same time reduces the over generation of skin cells, which is a common phenomenon for psoriasis patients. The drugs, which are administered, commonly on such patients, are acitretin (Soriatane), methotrexate as well as cyclosporine. These medicines see the patient through the acute stage of suffering. Thereafter the doctor may suggest for controlled exposure to UV lights along with psoralen, an oral light sensitizing drug.
Treatment of Palmoplantar Pustulosis
Palmoplantar Pustulosis normally affects the palm of the hands and sole of the feet. It is also known as localized pustular psoriasis. The patient suffering from this type of psoriasis finds reddening of skin having eruption like group of pustules, which in turn becomes brown in color and ultimately crust and peel over. The palmoplantar pustular psoriasis is initially treated with topical medicines like ointments, gel, lotions and creams. The commonly used topical medicines are; salicylic acid, corticosteroids, synthetic vitamin D, coal tar and a group of drugs commonly known as topical retinoids. However, in an obstinate palmoplantar pustular psoriasis case the doctor may treat it with acitretin, methotrexate or cyclosporine. UV light therapy is also used in deserving cases.
Treatment of Acropustulosis
Acropustulosis type of pustular psoriasis is found in rare cases and is afflicted with skin injury near the fingertips and toes. This aggravates pain and result in deformities of the nails and local bone structure. The treatment for this type of psoriasis has no special type of drugs and methods but follows the normal method as other type of psoriasis. In some patient acropustulosis is difficult to handle and the treatment may linger for quite some time until an effective drug is found to respond.
Home remedies for pustular psoriasis
1. Skin care
The blisters of psoriasis are not only painful but also ugly to look at. It helps the germs and bacteria to penetrate the skin of the body and develop infections. Therefore, it is prudent to keep the skin clean while treating it for psoriasis. Bathing in warm and disinfected water mixed with Epsom salts, mild oil or colloidal oatmeal, keeps the skin healthy and free from infection. If scales have appeared, you may remove them with a soft cloth. Before performing your daily chore and before going to sleep at night, the affected person should use a thick, oil-rich moisturizer. While going for night sleep you may wrap the affected portions in a plastic wrapper so that the moisturizer do not stick to the bed and keeps the skin moist.
2. Medicine for skin
If the skin appears to be inflamed and have blisters, you may buy over the counter topical medicines and use it on a daily basis. However, check for inclusion chemicals like salicylic acid or hydrocortisone in the topical medicines. These chemicals are found to be helpful in ameliorating the aggravation.
Filed under: Psoriasis