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Types of pustular psoriasis

Von Zumbusch

The onset of von Zumbusch pustular psoriasis can be abrupt. The condition begins with the development of reddened, painful and tender skin over much of the body, followed in a matter of hours by pustules. Over the next 24 to 48 hours, the pustules then dry and peel, leaving the skin with a glazed, smooth appearance. A fresh crop of pustules may then appear. Eruptions often come in waves that last days or weeks.

Von Zumbusch pustular psoriasis is associated with fever, chills, severe itching, dehydration, rapid pulse rate, exhaustion, anemia, weight loss and muscle weakness.

Individuals experiencing the symptoms of von Zumbusch pustular psoriasis should go see a doctor immediately. Treatment for von Zumbusch pustular psoriasis often requires hospitalization for rehydration and initiation of topical and systemic treatments, which typically include antibiotics.

Von Zumbusch pustular psoriasis can be triggered by an infection; sudden withdrawal of topical or systemic steroids; pregnancy; and drugs such as lithium, propranolol (brand name Inderal) and other high blood pressure drugs; iodides and indomethacin (brand name Indocin).

Palmoplantar pustulosis

Palmoplantar pustulosis (PPP) is a type of psoriasis that causes pustules on the palms of the hands and soles of the feet. PPP is characterized by multiple pustules the size of pencil erasers in fleshy areas of the hands and feet, such as the base of the thumb and the sides of the heels. The pustules appear in a studded pattern throughout reddened plaques of skin, then turn brown, peel and become crusted. The course of PPP is usually cyclical, with new crops of pustules followed by periods of low activity.

Those who are at risk for PPP should refrain from smoking, as studies suggest that an abnormal response to nicotine can trigger flares in individuals with PPP.

Acropustulosis (acrodermatitis continua of Hallopeau)

This rare type of psoriasis is characterized by skin lesions on the ends of the fingers and sometimes the toes. The eruption occasionally starts after an injury to the skin or infection. Often the lesions are painful and disabling, producing deformity of the nails. Bone changes can occur in severe cases.