Background

This variant of psoriasis is a distinct disease entity. It is rare and dramatic presentation of numerous pustules associated with fever and other constitutional symptoms. There may be associated arthritis, erythroderma, hypocalcemia, and migratory glossitis of the tounge.

Clinical Settings

Long history of psoriasis with provacative agent	Sunlight, UV radiation, alcohol, malignancy, hypocalcemia, NSAIDS, lithium, iodides, beta blockers, penicillin, sulfonamides, progesterone
Preceding psoriasis with atypical features	Onset is usually late in life
Arising without preexisting psoriasis

Variants of Pustular Psoriasis

Von Zumbusch	Most common variant Explosive onset 30% mortality
Impetigo herpetiformis	Flexural surfaces with centripetal spread May be a variant of psoriasis in pregnancy Fetal mortality is high
Acral variant	Arises in acrodermatitis continua Localized to one or more digits with dystrophy of nails
Exanthematic form
Annular variant
Localized form	Pustular psoriasis arising in preexisting plaques of psoriasis

The histology shows intraepidermal pustules with only mild epidermal hyperplasia, unlike classical psoriasis. There are dilated blood vessels within the superficial dermis associated with lymphocytes.

Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.

See Psoriasis.

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Last Updated 6/22/2001