This variant of psoriasis is a distinct disease entity. It is rare and dramatic presentation of numerous pustules associated with fever and other constitutional symptoms. There may be associated arthritis, erythroderma, hypocalcemia, and migratory glossitis of the tounge.
Long history of psoriasis with provacative agent Sunlight, UV radiation, alcohol, malignancy, hypocalcemia, NSAIDS, lithium, iodides, beta blockers, penicillin, sulfonamides, progesterone Preceding psoriasis with atypical features Onset is usually late in life Arising without preexisting psoriasis
Variants of Pustular Psoriasis
Von Zumbusch Most common variant
Impetigo herpetiformis Flexural surfaces with centripetal spread
May be a variant of psoriasis in pregnancy
Fetal mortality is high
Acral variant Arises in acrodermatitis continua
Localized to one or more digits with dystrophy of nails
Exanthematic form Annular variant Localized form Pustular psoriasis arising in preexisting plaques of psoriasis
The histology shows intraepidermal pustules with only mild epidermal hyperplasia, unlike classical psoriasis. There are dilated blood vessels within the superficial dermis associated with lymphocytes.
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
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