Pustular Psoriasis

About 3% of people living with psoriasis develop pustular psoriasis.

It is often seen in older adults, although it can start at any age.

(Wilson et al., 2009)

Did You Know?

Symptoms

Symptoms of pustular [PUHS-choo-lar] psoriasis include pustules (white or yellow, pus-filled, painful bumps) that may be surrounded by inflamed or reddened/discolored skin. The pus in pustules is caused by inflammation and is not contagious. People with plaque psoriasis or other types of psoriasis may also develop pustular psoriasis.

(Image curtesy of Callis-Duffin, University of Utah.)

Pustular psoriasis on the hand, found on the Symptoms section of the page.

There are different types of pustular psoriasis that depend on where the symptoms appear:

Generalized pustular psoriasis (GPP) affects large areas of the body.

GPP can develop suddenly and progress quickly and often comes with a fever, chills, severe itching, change in heart rate, fatigue, and muscle weakness. See a health care provider immediately if you think you have GPP.
Learn more about GPP

Localized pustular psoriasis

Palmoplantar Pustular Psoriasis (PPPP) is when symptoms affect the palms of the hands and/or the soles of the feet. This type often affects the base of the thumbs and the sides of the heels.
Learn more about PPPP
Acrodermatitis continua of Hallopeau (ACH) is when symptoms affect only the tips of the fingers and/or toes, particularly the nail. This type is very rare and may present after an injury to the skin or infection.
Learn more about ACH

Triggers

Several factors may trigger pustular psoriasis, including:

Certain medicines (ex. antimicrobials or systemic steroids)
Starting or stopping medicines
Exposure to too much ultraviolet (UV) light
Infections (ex. Streptococcus or Staphylococcus)
Pregnancy
Stress

Treatment

Topicals, phototherapy, oral treatments and biologics are all possible treatment options for pustular psoriasis. You and your health care provider will discuss the best treatment plan for you based on the severity of your symptoms and your medical history. Although there are no treatments specific to pustular psoriasis, continued research and collaboration between health care professionals and scientists are opening avenues to more targeted therapies.

Pustular Psoriasis Resource Center

NPF is here to help with resources, advice and stories specifically for you to help live the healthy and happy life that you want.

Go to the Pustular Resource Center

References

Wilson, F. C., Icen, M., Crowson, C. S., McEvoy, M. T., Gabriel, S. E., & Kremers, H. M. (2009). Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum, 61(2), 233-239. doi:10.1002/art.24172

Bachelez H. Pustular psoriasis: The dawn of a new era. Acta Derm Venereol. Jan 30, 2020; 100(3): adv00034. doi:10.2340/00015555-3388.

Twelves S, Mostafa A, Dand N, et al. Clinical and genetic differences between pustular psoriasis subtypes. J Allergy Clin Immunol. Mar 2019; 143(3): 1021-1026. doi:10.1016/j.jaci.2018.06.038.

Last updated on 12/30/2022 by the National Psoriasis Foundation.