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Pustular psoriasis: Management

Robert E Kalb, MD
Section Editor
Kristina Callis Duffin, MD
Deputy Editor
Abena O Ofori, MD


Pustular psoriasis is an uncommon subtype of psoriasis that may present as a generalized or localized pustular skin eruption. The goals of treatment of generalized pustular psoriasis (GPP) are to improve skin manifestations, to alleviate associated systemic symptoms, and to minimize risk for life-threatening systemic complications. Treatment of localized pustular psoriasis is indicated to minimize the development of bothersome or disabling symptoms.

The treatment of generalized and localized pustular psoriasis will be reviewed here. The clinical features of pustular psoriasis, the management of pustular psoriasis in pregnant women (impetigo herpetiformis), and the management of other forms of psoriasis are reviewed separately. (See "Pustular psoriasis: Pathogenesis, clinical manifestations, and diagnosis" and "Dermatoses of pregnancy" and "Treatment of psoriasis" and "Guttate psoriasis".)


Generalized pustular psoriasis (GPP) is characterized by the development of a widespread eruption of pustules and erythematous plaques (picture 1A-C). A preceding history of psoriasis may or may not be present. The acute variant (also known as generalized pustular psoriasis of von Zumbusch) is characterized by sudden onset of the pustular eruption accompanied by systemic symptoms of fever and malaise. Laboratory abnormalities, such as leukocytosis, an elevated erythrocyte sedimentation rate, hypocalcemia and other electrolyte abnormalities, hypoalbuminemia, and elevated liver enzymes are common. In addition, serious complications, including sepsis and hepatic, respiratory, or renal dysfunction can occur [1-4]. (See "Pustular psoriasis: Pathogenesis, clinical manifestations, and diagnosis", section on 'Generalized pustular psoriasis'.)

GPP may also present as a less acute disorder in which patients develop widespread annular or figurate erythematous plaques with peripheral pustules and scale (generalized annular pustular psoriasis) [4,5]. Pain and fever may accompany these cutaneous manifestations. (See "Pustular psoriasis: Pathogenesis, clinical manifestations, and diagnosis", section on 'Clinical manifestations'.)

There is no cure for GPP and recurrences are common [4]. Thus, long-term treatment often is required to minimize recurrences of disease.


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Literature review current through: Sep 2016. | This topic last updated: Jul 15, 2016.
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