assessment of acute pustular psoriasis
Last edited 08/2019
Assessment of acute pustular psoriasis:
- clinical assessment
- pustular psoriasis appears as numerous discrete and confluent superficial,
yellowish pustules on a background of erythema
- can be diffuse or localized
- a full body skin examination should be performed, including careful evaluation of the mucous membranes and the nails for signs of psoriasis and to exclude other causes of pustulosis
- pustular psoriasis starts as red papules or plaques that quickly
evolves into yellowish, superficial pustules on a background of erythema
- generalized psoriasis
- generalized von Zumbusch subtype usually presents with systemic
symptoms like fever, joint pain, headaches, and leukocytosis
- in contrast, the exanthematic subtype presents as an acute pustular eruption without systemic symptoms
- annular subtype is seen more frequently in children as annular
lesions with pustules along the advancing edge
- generalized von Zumbusch subtype usually presents with systemic
symptoms like fever, joint pain, headaches, and leukocytosis
- localized pustular psoriasis
- acrodermatitis continua of Hallopeau affects the finger, toes, and nailbeds
- palmoplantar psoriasis, which can be seen as part of SAPHO (Synovitis,
acne, pustulosis, hyperostosis and osteitis) syndrome, affects the
palms and soles
- clinician should inquire about the trigger factors in patients who present
with pustular psoriasis, especially the use of medications like corticosteroids.
Family history is important to ascertain since there is a genetic element
responsible for the disease
- pustular psoriasis appears as numerous discrete and confluent superficial,
yellowish pustules on a background of erythema
- laboratory assessment:
- patients with suspected pustular psoriasis require careful evaluation, as the von Zumbusch subtype can be life-threatening
- laboratory tests include:
- FBC, U+Es, bone profile, LFTs
- to assess leukocytosis, electrolyte balance, hypocalcemia, transaminases and albumin
- a pregnancy test should be ordered in women of childbearing age
- a punch biopsy can be performed in all equivocal cases.
- FBC, U+Es, bone profile, LFTs
Reference:
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome