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Papulosquamous Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Melek Aslan Kayıran, Jordan V. Wang, Ayşe Serap Karadağ
Pustular psoriasis is a clinical variant in which pustules are located on erythematous areas, which can be generalized or localized. It is seen at the rate of 1.2–1.8% among all forms of psoriasis. Its acute generalized form is also called von Zumbusch disease (Figure 4.3). Patients typically have fever, and pustules appear suddenly. It is more common between 30–50 years and in women. Its etiology includes drugs, such as terbinafine, amoxicillin, sulfonamides, and lithium, as well as infection, pregnancy, hypoparathyroidism, hypocalcemia, and ultraviolet radiation. Occasionally, it can emerge as a result of the sudden discontinuation of treatments in patients with psoriasis. Eye and nail involvement, along with a geographic tongue, can be observed. Fever, arthralgia, myalgia, malaise, and abdominal pain are common.
Psoriasis and lichen planus
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
The role of topical corticosteroids in the treatment of psoriasis is limited owing to their side effect profile and rebound flare-up of the disease after stopping them. Life-threatening generalized pustular psoriasis can result after sudden withdrawal. They are useful for patients with flexural lesions for which other irritant preparations are not suitable. For the same reason, weak topical corticosteroids are also suitable for lesions on the genitalia and the face where potent topical corticosteroids cannot be used.Systemic steroids can be used ONLY in the following indications:Generalized pustular psoriasis of pregnancy/erythroderma: this is the ONLY definitive indication for using oral steroids.Persistent and uncontrolled erythrodermic psoriasis causing metabolic complications.Generalized pustular psoriasis if other drugs are contraindicated or not effective.Severe polyarthritis that could lead to irreversible joint damage.
Psoriasis
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Excessive exfoliation may even lead to loss of protein, iron and folate. The term 'guttate psoriasis' is used when psoriatic areas are seen all over the body, usually after a few weeks of streptococcal sore throat. 'Pustular psoriasis' is characterized by the presence of numerous sterile pustules, an acute episode of fever, chills, leucocytosis, hypocalcaemia and hypoalbuminaemia. This form of psoriasis requires urgent treatment.
Psoriasis: talking points from recent clinical trials
Published in Expert Opinion on Investigational Drugs, 2022
Andrea Chiricozzi, Francesco Bellinato, Paolo Romita, Paolo Gisondi
For moderate-to-severe plaque psoriasis, an additional and valid option would be represented by deucravacitinib that showed superior efficacy compared with apremilast and a more favorable safety profile compared with other JAK inhibitors, because of its mode-of-action that reduces off-target effects (herpes zoster reactivation, opportunistic infections, thromboembolic events, dyslipidemia, JAK2-dependent hematopoietic function). Contrary to plaque psoriasis, only one biologic agent (spesolimab) has been approved for the treatment of GPP so far. Because the management of pustular psoriasis often results unsatisfactory with the available treatment options, a therapeutic need is still not fulfilled. The evaluation of efficacy and safety of any therapeutic investigated for GPP might result challenging in a clinical trial setting in particular for patient recruitment, mostly due to the rarity of the condition. Notably, the occurrence of GPP could have been further reduced through the last two decades because of the continuous, long-term use of biologic treatments for plaque psoriasis that has likely prevented the onset of GPP after withdrawal from systemic steroids or cyclosporine in patients with plaque psoriasis. However, the future of GPP treatment is encouraging and offers the potential of better patient care improving quality of life for patients affected by this severe and potentially life-threatening disease.
Economic burden of generalized pustular psoriasis and palmoplantar pustulosis in the United States
Published in Current Medical Research and Opinion, 2021
Maya L. Hanna, David Singer, Wendell C. Valdecantos
Pustular psoriasis is a group of inflammatory skin conditions characterized by sterile pustules that can be distributed across the body or localized1,2. Generalized pustular psoriasis (GPP) and palmoplantar pustulosis (PPP) are two sub-classifications of pustular psoriasis with markedly different presentations. GPP, a severe type of pustular psoriasis, which can be distributed across the body, is characterized by rapidly progressing diffuse dark erythematous patches with pustules that coalesce to form lakes of pus2. GPP patients often experience fever, fatigue, hyperleukocytosis, and other symptoms such as pain throughout the course of the disease with periods of disease quiescence and recurrence over the course of months, and even years1,3. Patients with GPP may also experience flares which can lead to serious complications such as sepsis, renal failure, respiratory abnormalities, and even death4,5. In PPP, a localized form of pustular psoriasis, pustules are restricted to the palms of hands and soles of feet, accompanied by erythema, painful blistering, scales, and/or keratinization6,7. Both GPP and PPP can occur independently of a history of psoriasis1,8.
A brief guide to pustular psoriasis for primary care providers
Published in Postgraduate Medicine, 2021
Jeffrey J. Crowley, David M. Pariser, Paul S. Yamauchi
Pustular psoriasis refers to a heterogeneous group of inflammatory skin disorders, characterized by the presence of neutrophil-filled pustules. Pustular psoriasis sub-types are clinically, histologically, and genetically distinct from plaque psoriasis [7], although lesions can occur concurrently with those of plaque psoriasis [8]. Pustular psoriasis may present as a disseminated systemic illness (generalized pustular psoriasis [GPP]), or a localized disease affecting the palms/soles (palmoplantar pustulosis [PPP], also known as palmoplantar pustular psoriasis), or digits/nail beds (acrodermatitis continua of Hallopeau [ACH]) [9–11]. Pustular psoriasis is rare, accounting for ~1% of all cases of psoriasis [12]. Asian individuals tend to be affected by GPP more commonly than Caucasians. The estimated prevalence of GPP ranges from 1.76 per million in Europe to 7.46 per million in Japan [13,14]. The estimated prevalence of PPP ranges from 0.01% and 0.05% [15]; although, one large Japanese study reported a national prevalence of 0.12% [12].