Localized pustular psoriasis is a term that refers to a limited area of small pus-filled blisters on your skin, typically on your hands or feet. It is distinct from generalized pustular psoriasis (GPP) , which affects large areas of skin on the body and is a much more serious condition. There are several potentially effective treatments available for localized pustular psoriasis, but there is no cure for the condition. Getting an accurate diagnosis can be a challenge, since there are other skin conditions with similar symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e8d334af-72b7-4ce9-8dc7-ae41e7a924d6
Types of Localized Pustular Psoriasis Types Localized pustular psoriasis is generally understood to include two different types of psoriasis:e60dc2a1-f33c-4a05-9b50-8e3e8e597629bc30d7af-6982-4947-a9df-b97013c13a0f Palmoplantar Pustular Psoriasis (PPP or PPPP) Also known as palmoplantar pustulosis, this type of pustular psoriasis affects the palms of your hands, the soles of your feet, or both. Acrodermatitis Continua of Hallopeau (ACH) This type affects only the tips of your fingers or toes, often including the nails. Palmoplantar pustular psoriasis (PPP) is far more common than acrodermatitis continua of Hallopeau (ACH), which is very rare.e60dc2a1-f33c-4a05-9b50-8e3e8e597629291f5cdc-df3b-4ff2-af92-17bbcb58a628 In fact, some researchers believe that ACH should actually be considered a rare form of PPP.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290356bfee-8308-49e6-925f-4fca05785ea2 Sometimes, a person with plaque psoriasis may develop pustules within the area of their plaques. “You can have limited plaque psoriasis that includes some areas that are pustular” without it being considered a separate type of localized pustular psoriasis, says Kimberly Katz, MD , a dermatologist at University of Washington Medicine in Seattle.
Signs and Symptoms of Localized Pustular Psoriasis Symptoms Localized pustular psoriasis is distinguished by pustules — white or yellow painful, pus-filled bumps — in the affected area of skin. These pustules may be surrounded by red, discolored, or inflamed skin.e60dc2a1-f33c-4a05-9b50-8e3e8e597629111d7b26-397b-4d84-971c-265ba944bd52 A flare of palmoplantar pustular psoriasis often involves scattered white or yellow pustules on areas of discolored skin. As they dry out over time, these pustules can turn darker or brown. The affected skin areas can also become scaly or cracked, potentially with deep cracks or breaks in the skin (fissures). Outbreaks can last for a very long time, potentially months or even years.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297dcbfed1-d591-43fe-977e-14bfe14b7079 “Psoriasis on the hands and feet can affect quality of life in an enormous way,” says Dr. Katz. “There are lots of nerves on the hands, and we use them so much. And it’s very visible.”
Causes and Risk Factors of Localized Pustular Psoriasis Causes Like other forms of psoriasis, the causes of localized pustular psoriasis are not well understood. Psoriasis lesions — including pustules — happen when an overactive immune system speeds up the growth of skin cells.e60dc2a1-f33c-4a05-9b50-8e3e8e59762918afaffa-98f5-4e2d-8e0f-74a56c874ca0 Pustules, in particular, develop when immune system cells called neutrophils build up in the outermost layers of your skin.e60dc2a1-f33c-4a05-9b50-8e3e8e597629aaf7708d-bae0-4671-b5ba-2aa94e463f39 Several factors may trigger the onset of localized pustular psoriasis, including:e60dc2a1-f33c-4a05-9b50-8e3e8e59762918afaffa-98f5-4e2d-8e0f-74a56c874ca0e60dc2a1-f33c-4a05-9b50-8e3e8e597629aaf7708d-bae0-4671-b5ba-2aa94e463f39 Starting or stopping certain medications Ultraviolet (UV) light exposure Skin infections Stress or changes to your routine Pregnancy Women are more than three times as likely as men to develop palmoplantar pustular psoriasis. It’s estimated that about 80 percent of people with palmoplantar pustular psoriasis are current or former smokers.e60dc2a1-f33c-4a05-9b50-8e3e8e597629803a4493-4079-48d7-928e-ec4599a8d12e
How Is Localized Pustular Psoriasis Diagnosed? Diagnosis A diagnosis of localized pustular psoriasis will be based on several factors, including:e60dc2a1-f33c-4a05-9b50-8e3e8e597629f4131f51-8518-4355-ac3b-39150b2fb6e5 Physical exam Your history of symptoms Your complete medical history Skin biopsy (tissue sample) and testing Blood tests to help rule out generalized pustular psoriasis (GPP) In a physical exam, your provider will be looking at the appearance and location of pustules and other features of your skin.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295a284e59-30c8-426b-b399-9d0b92dab236 Testing a skin biopsy may help determine the cause of your pustules, and distinguish pustular psoriasis from other skin conditions that can cause similar symptoms, such as an allergic skin reaction.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f4131f51-8518-4355-ac3b-39150b2fb6e5 “Often the patient’s history plays a large role” in the diagnostic process, says Katz. “Pustular psoriasis is more common if someone has a history of psoriasis.” And often, knowing a person’s medication history is key to ruling out a drug reaction as the cause of their symptoms. “Under the microscope, pustular drug reactions can look just like pustular psoriasis,” Katz says.
Treatment and Medication Options for Localized Pustular Psoriasis Treatment There are a few main goals of treatment for localized pustular psoriasis: Clearing pustules from skin Relieving pain or itching Preventing side effects and complications Treatment options may include topical, oral, or injected or infused medications, along with other measures like phototherapy.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292749e31a-da00-42ae-a8d2-bd3afee1b359 Medication Options For less severe forms of localized pustular psoriasis, the following topical treatments may be used alone or in combination:e60dc2a1-f33c-4a05-9b50-8e3e8e59762950c2ef4a-1058-4ef0-b68c-00e52cdda9fe Corticosteroids (steroids) Synthetic vitamin D Salicylic acid For more severe forms of localized pustular psoriasis, the following drugs may be prescribed:e60dc2a1-f33c-4a05-9b50-8e3e8e59762950c2ef4a-1058-4ef0-b68c-00e52cdda9fe Oral retinoids Biologic medications One research review found that the current evidence doesn’t support any particular treatment protocol for palmoplantar pustular psoriasis — and that the track record for biologic drugs in particular is mixed, with only very slow improvements and many people not tolerating the drugs well.e60dc2a1-f33c-4a05-9b50-8e3e8e59762919693f1f-3415-499d-8a13-108cc1d2b54f For acrodermatitis continua of Hallopeau, a research review found that oral retinoids and biologic drugs could both be effective treatments. A nonbiologic drug called apremilast (Otezla), which is prescribed for other forms of psoriasis, was also found to be somewhat effective.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291c51475c-183c-4f72-acfc-1a62b37499ef Phototherapy Also known as light therapy, phototherapy involves exposure to different wavelengths of light. One common form of this therapy is known as PUVA; a person takes a drug called psoralen and then has affected areas exposed to UVA, a type of ultraviolet light.e60dc2a1-f33c-4a05-9b50-8e3e8e59762950c2ef4a-1058-4ef0-b68c-00e52cdda9fe
Prevention of Localized Pustular Psoriasis Prevention There’s no known way to prevent localized pustular psoriasis. But if you have the condition, you may be able to reduce your risk of a flare-up by taking the following steps:e60dc2a1-f33c-4a05-9b50-8e3e8e5976293e5b91c4-fb55-47bb-a5f5-7f85b47e1086 Clean the area frequently with a gentle cleanser. Moisturize regularly. Keep stress under control. Avoid known or suspected triggers.
How Long Does Localized Pustular Psoriasis Last? Prognosis and Outlook A flare-up of localized pustular psoriasis can take a long time to completely resolve — from a couple of weeks to a few months, depending on your response to different treatments. There is no cure for localized pustular psoriasis, but you may be able to reduce or avoid future flare-ups by paying attention to potential triggers like irritants or allergens. Talk to your healthcare provider about identifying possible triggers if you aren’t sure.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291c4bc54b-d6cb-4e04-a618-2398a6cced68
Complications of Localized Pustular Psoriasis Complications People with localized pustular psoriasis may develop psoriatic arthritis , a form of arthritis that is also linked to other types of psoriasis. Some research suggests that about 30 percent of people with palmoplantar pustular psoriasis go on to develop musculoskeletal disease such as psoriatic arthritis.e60dc2a1-f33c-4a05-9b50-8e3e8e59762968c69413-ff3f-4b47-ab62-fcb26ba629b6 Effective treatment for localized pustular psoriasis can reduce the risk of complications and related conditions, including psoriatic arthritis, heart disease, and depression.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293c650c0e-bccb-492a-bcad-1698d1c26abb
The Takeaway If you experience painful, pus-filled blisters on your hands or feet, consult a healthcare professional for an accurate diagnosis and appropriate treatment. There is no cure for localized pustular psoriasis, but several treatments exist that may improve the symptoms and help you manage the condition effectively. To reduce flare-ups of localized pustular psoriasis, try to identify and avoid potential triggers, manage your stress level, and regularly clean and moisturize the affected areas.
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