Assessment of acute pustular psoriasis

Assessment of acute pustular psoriasis: (1)

• 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
      
      
  • 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
    
    
• 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 leucocytosis, electrolyte balance, hypocalcaemia, transaminases and albumin
    • a pregnancy test should be ordered in women of childbearing age
    • a punch biopsy can be performed in all equivocal cases.

Reference

1. Romiti R, Hirayama ALDS, Arnone M, et al; Generalized pustular psoriasis (von Zumbusch). An Bras Dermatol. 2022 Jan-Feb;97(1):63-74.