Psoriasis, Pustular

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Image of Psoriasis, Pustular

VisualDx images show variation in age, skin color, and disease stage. VisualDx has 76 images of Psoriasis, Pustular.

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ICD Codes

ICD-9-CM:
696.1 – Other psoriasis

ICD-10-CM:
L40.1 – Generalized pustular psoriasis

Synopsis

Pustular psoriasis is an uncommon variant of psoriasis that is characterized by the presence of widespread, erythematous, sterile pustules on clinical examination and a predominantly neutrophilic infiltrate on a cellular level. Pustular psoriasis can be a severe inflammatory disease that requires hospitalization and aggressive therapy. Untreated disease can also progress to erythroderma. While many cases are idiopathic, risk factors that can trigger an episode include hypocalcemia, infection, a rapid withdrawal of corticosteroids (or weeks after an IM injection), pregnancy, medications (salicylates, lithium, iodine, trazodone, penicillin, interferon, hydroxychloroquine), and topical irritants such as tar and anthralin. Only a small number of patients have a preceding history of plaque-type psoriasis.

There are 4 subtypes of pustular psoriasis. In the von Zumbusch type, there is an acute onset of generalized erythema and pustules with systemic manifestations including fever, skin tenderness, malaise, arthralgias, headache, and nausea. After several days, the pustules resolve to become confluent, scaling plaques. The exanthematic type is characterized by the acute onset of small pustules that are triggered by an infection or a drug. This subtype usually lacks systemic symptoms. The annular subtype is characterized by erythematous, annular lesions that have pustules at the advancing edge of a lesion and is associated with fever, malaise, and other systemic manifestations. The localized pattern occurs when pustules appear in existing psoriatic plaques. This can be seen in active plaques. Note that pustular psoriasis that occurs during pregnancy is termed impetigo herpetiformis.

Patients may experience relapses and remissions over a period of years. There is no racial predilection. Pustular psoriasis may occur in children but is more commonly seen in middle-aged adults.

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