Psoriasis: generalised pustular psoriasis (syn. von Zumbusch psoriasis)

Generalised pustular psoriasis is a rare form of psoriasis, which presents as widespread pustules on a background of red and tender skin. Another form of pustular psoriasis occuring on the hands and feet is known as palmoplantar pustulosis and is discussed in the related chapters. 

This chapter is set out as follows:

• In most patients no identifiable cause can be found although some people with generalised pustular psoriasis have a preceding history of chronic plaque psoriasis
   
• Triggers include:
  • Withdrawal of systemic corticosteroids or very potent topical steroids in a patient with known psoriasis 
  • Drugs such as lithium and salicylates
  • Pregnancy 

• Patients often have systemic upset with sore skin, fever and malaise

• Initially the patient develops red, angry looking tender patches of skin 
• Within a few hours 1-2 mm pustules arise on parts of the skin especially the flexures and genitalia. After a day or so the pustules coalesce to form lakes of pus, which then dry and peel to leave behind a glazed, smooth surface on which new crops of pustules may appear
• Large areas of skin can be affected 

• Patients are often very unwell and need admission - the most appropriate course of action is to phone the on call dermatologist