Pustular Psoriasis On Hands: Its Causes, Symptoms And Treatment

Psoriasis is a chronic skin disease with an unknown etiology. However, researchers suspect involvement of genetics and environmental factor. Pustular psoriasis is one of its forms. It is not a common form of psoriasis. As the name suggests, the skin lesion is filled with white thick fluid, composed of pus. However, this pus does not consist of any organisms and it is not infective.

The skin changes such as raised red scaly lesions otherwise are similar to regular form of psoriasis. Pustular psoriasis can be generalized where large part of skin is involved.

Sometimes patient may suffer from fever. The disease can be localized in palms and soles and on fingertips and nails. There is no race discrimination and the average age for people suffering from pustular psoriasis is 50 years.

What Causes Pustular Psoriasis?

Researchers believe genetics and environment play an important role in the development of pustular psoriasis. Here are some of the trigger causes:

  • Patient taking oral and steroid injections and then suddenly discontinuing them.
  • Certain medicines and drugs: Salicylic acid, iodine, antidepressants, penicillin, antimalarial medicines etc.
  • Infections
  • Pregnancy
  • Ultraviolet rays of sun and ultraviolet light used in photo therapy.
  • Jaundice
  • Hypocalcaemia

Symptoms Of Pustular Psoriasis On Hands

Pustular psoriasis is also present on palms, soles and hands. Often it is accompanied with inflammatory changes in palms and soles. The palm and sole area is covered with tiny pustules and it is fiery red. The lesions are recurrent. The condition is painful.

The generalized variety is most severe. The skin becomes red and it is painful when touched. Other presenting systemic symptoms may include headache, fever, chills, pain in large as well as small joints, loss of appetite, nausea etc. Soon after, the skin involved fills with plenty of tiny pustules.

Commonly they develop in bends and skin folds, in anus and genital area of men and women. In some cases, they may appear on the face and tongue. When the lesions are present on the tongue, patient may have difficulty swallowing. The pustules may also develop under the nail. In such circumstances, there is a possibility of nail falling off.

After two to three days, the tiny pustules may fuse together and form a large layer of pus filled lesion. This then dries and peels off. Underneath there is smooth red surface of skin where tiny pustules are in the developing stage. This whole cycle of development and peeling off may last for several weeks and months. Patient may start losing hair from that area.

In ring shaped form, which is more common in children, the scaly lesions appear in ring shape and at the periphery there are tiny pustules.

Treatment For Pustular Psoriasis

Since the generalized variety of pustular psoriasis is severe, the patient should be hospitalized and treated. In such circumstances, the patient needs adequate amount of fluids and rest. Cold sponging is applied on the skin for comfort and relief. Patient also feels better with oatmeal bath.

  • The first line of treatment consists of topical ointments. Steroid and vitamin D3 derivative are often used.
  • In some cases use of ultraviolet –B light may be a treatment of choice.
  • In certain cases drugs such as methotrexate and cyclosporin are found to be effective. This treatment is prescribed and closely observed by the doctor.

Alternative therapy is also helpful.

  • Patient should reduce stress. Yoga and meditation are useful in such cases.
  • Certain dietary changes may play an important role in reducing the recurrence of pustular psoriasis.
  • Patient should avoid alcohol, smoking, etc which may aggravate the condition.

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