Doctors caring for patients with pustular psoriasis—a rare form of psoriasis characterized by white blisters surrounded by red skin—should consider the severity of the disease and the extent of involvement on the body when determining treatment, according to new consensus recommendations from the National Psoriasis Foundation Medical Board. They note that very limited data exists on the treatment options for pustular psoriasis and more study is needed.
The Medical Board recommends the following medications as first-line treatment for generalized, or widespread, pustular psoriasis: Soriatane (acitretin), methotrexate and cyclosporine. For patients with extensive, acute disease, the biologic agent Remicade also is recommended as a first-line therapy.
Further recommendations include the use of the biologics Humira and Enbrel, and light therapy known as PUVA—psoralen plus ultraviolet light A—as second-line treatments.
Children and pregnant women require special considerations due to treatment side effects. Soriatane, cyclosporine, methotrexate and Enbrel should be used as first-line therapies for juvenile pustular psoriasis followed by Humira, Remicade and UVB phototherapy for second-line treatment. For patients with pustular psoriasis in more localized areas—such as palmarplantar pustular psoriasis, which affects the palms of the hands and soles of the feet—topical steroids and light therapy are recommended as first-line treatment.
The treatment recommendations for pregnant women include first-line therapy with cyclosporine, oral corticosteroids and topicals, followed by light therapy as second-line treatment.
Learn more about the types of pustular psoriasis »