Pustular Psoriasis ICD-10: L40.1

Rare inflammatory skin disease / Psoriasis variant

Often searched as: pus filled bumps on palms, blisters on hands and feet, pustules on palms and soles, pus bumps with red skin, psoriasis with pus, white bumps on hands psoriasis, blisters that aren't itchy but hurt, widespread pus rash with fever…

Clinical urgency level

lowmediumhigh

Systems Affected

skinjoints (in some cases)systemic (in generalized forms — fever, electrolyte imbalance)

Severity Levels

mild

Palmoplantar pustulosis (PPP) — localized to palms and soles, chronic, not life-threatening, but significantly impacts function and quality of life.

moderate

Annular or acrodermatitis continua variant — recurring, expanding, affects digits or larger skin areas, requires systemic treatment.

severe

Generalized pustular psoriasis (GPP / Von Zumbusch) — acute, widespread, life-threatening with systemic inflammation, fever, electrolyte disturbances — medical emergency requiring hospitalization.

Red Flags

Rapid spread of pustules across large body areas with fever and feeling very unwell (GPP — medical emergency)
Pustular psoriasis during pregnancy (impetigo herpetiformis — risk to mother and fetus)
Pustules accompanied by joint swelling, pain, or limited movement
Electrolyte imbalance symptoms: muscle cramps, weakness, confusion
Existing psoriasis patient suddenly developing widespread pustules after stopping systemic treatment abruptly
Skin becoming red, painful, and hot over large areas (erythrodermic component)

Clinical Presentation

Palmoplantar pustulosis — sterile pustules on the palm

Source: Wikimedia Commons (CC BY-SA 3.0 )

Pustular psoriasis image gallery — DermNet NZ

View gallery on DermNet NZ (image gallery reference)

When to See a Doctor

Seek emergency care immediately if you develop widespread rapidly spreading pustules with fever and feeling unwell — this is generalized pustular psoriasis (GPP) and is a medical emergency. See a dermatologist promptly for any new pustular rash on the hands or feet that doesn't respond to topical treatments, or if you have known psoriasis and develop pustules.

Differential Diagnosis

Palmoplantar eczema (dyshidrotic — vesicles, not pustules; very itchy)
Acute generalized exanthematous pustulosis (AGEP — drug reaction, resolves quickly)
IgA pemphigus
Subcorneal pustular dermatosis (Sneddon-Wilkinson)
Impetigo (infectious — crusted, positive culture)
Secondary syphilis with pustular component

Comorbidities

Plaque psoriasis (may coexist or precede GPP)
Psoriatic arthritis
Metabolic syndrome
IL-36 pathway mutations (GPP — genetic basis in many cases)
Depression and anxiety
Pregnancy-associated GPP (impetigo herpetiformis)

Prognosis

Localized forms (palmoplantar pustulosis, acrodermatitis continua) are chronic but not life-threatening. They respond variably to topical and systemic treatments; biologics (anti-IL-17, anti-IL-23, spesolimab for GPP) have improved outcomes significantly. Generalized pustular psoriasis (GPP) has historically carried significant mortality in untreated cases due to systemic complications, but spesolimab (first GPP-specific biologic, approved 2022) has transformed acute management. Long-term remission is achievable with appropriate maintenance therapy.

Detailed Overview

Causes, Symptoms, and When to Take Action Pustular psoriasis is a rare and distinct form of psoriasis characterized by sterile pustules on red and inflamed skin. It may involve localized areas or become widespread, sometimes affecting general health. How It Looks Texture: Red, inflamed skin with clusters of small pustules Color: Yellowish or white pustules on erythematous base Shape: Varies by subtype — can appear in rings (annular), on palms/soles, or widespread patches Location: Localized forms affect palms, soles, digits. Generalized forms are widespread across the body. Why Does It Appear? Pustular psoriasis results from a complex interplay of genetic predisposition, skin inflammation, and triggering factors. Genetic mutations affecting immune pathways may underlie susceptibility. Triggers can include infections, stress, and other environmental factors. Should You Be Concerned? While some forms remain localized and manageable, generalized pustular psoriasis can be serious and may require urgent evaluation. Warning signs include rapid spread of pustules over large areas, systemic symptoms like fever or malaise, and persistent or recurrent flares. Can You Prevent It? Managing known triggers, monitoring skin changes vigilantly, and seeking timely care when symptoms emerge help reduce severity. 👉 How Piel AI Can Help Piel AI supports tracking lesion changes over time through regular imaging. While not diagnostic, it helps you observe flare patterns and share visual documentation with healthcare professionals. Summary Pustular psoriasis is a rare inflammatory skin condition marked by sterile pustules on red skin. It can be localized or generalized; generalized forms may have serious implications. Genetic and environmental factors contribute to its occurrence. Close monitoring and prompt professional care are crucial.

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