Fast Five Quiz: Can You Recognize Different Types of Psoriasis?

Dirk M. Elston, MD


August 11, 2020

Figure 5. Close up of foot with pustular psoriasis.

Pustular psoriasis is an uncommon form of psoriasis consisting of widespread pustules on an erythematous background. The oropharyngeal mucosa may be hyperemic, and a geographic or fissured tongue may be present. Individuals with acute generalized pustular psoriasis often have fever with accompanying toxicity, which can be fatal if not quickly treated during the acute phase. Patients may appear upset and often are tachypneic and tachycardic. Lesions typically are on the trunk and extremities and very rarely appear on the face. Although the onset can be idiopathic, known triggers include withdrawal of steroids (systemic or topical); strong irritating topical agents (eg, tar, anthralin); cutaneous infections; and exposure to certain oral and topical medications, and sunlight or phototherapy.

Treatment strategies are guided by patient condition and extent of skin involvement. First-line therapies include oral retinoids, methotrexate, cyclosporine, and infliximab. Hospitalization is sometimes required in patients with generalized pustular psoriasis to ensure hydration and bed rest and prevent excessive heat loss. Read more about pustular psoriasis here.


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