eMedicine Specialties > Dermatology > Papulosquamous Diseases

Psoriasis, Pustular: Follow-up

Author: Carlos Ricotti, MD, Fellow, Department of Dermatology, Division of Dermatopathology, University of Texas Southwestern School of Medicine
Coauthor(s): Clay J Cockerell, MD, Director, Clinical Professor, Department of Dermatology, Division of Dermatopathology, University of Texas Southwestern Medical Center
Contributor Information and Disclosures

Updated: Dec 29, 2009

Follow-up

Complications

  • Death in pustular psoriasis may occur as a result of cardiorespiratory failure. This usually happens only in untreated patients. Occasionally, acute respiratory distress syndrome may complicate generalized pustular psoriasis.
  • Other complications in pustular psoriasis may include the following: 
    • Secondary bacterial skin infections, hair loss (telogen effluvium), and nail loss
    • Hypoalbuminemia secondary to loss of plasma protein into tissues
    • Hypocalcemia
    • Renal tubular necrosis as a result of oligemia
    • Liver damage as a result of oligemia and general toxicity
    • Malabsorption and malnutrition

Prognosis

  • Older patients with von Zumbusch-type of pustular psoriasis have a poor prognosis.
  • Death can result from cardiorespiratory failure during the acute erythrodermic stage.
  • Patients with chronic psoriasis vulgaris prior to a generalized pustular episode tend to have a better prognosis than patients with more atypical forms of psoriasis prior to the pustular flare.
  • In children, as long as serious secondary infections are avoided, episodes of pustular psoriasis have a good prognosis.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to institute prompt supportive measures to prevent cardiovascular decompensation in the erythrodermic stage
  • Failure to use systemic corticosteroids conservatively: Aggressive use may result in complications such as severe secondary infection and aseptic hip necrosis.
  • Failure to adequately disclose possible adverse effects of therapies such as acitretin, PUVA, and methotrexate
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Elma Baron, MD, and Charles Taylor, MD, and previous Chief Editor, William D. James, MD, to the development and writing of this article.



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Multimedia: Psoriasis, Pustular
References
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References

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Further Reading

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Keywords

psoriasis, pustular psoriasis, von Zumbusch psoriasis

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Contributor Information and Disclosures

Author

Carlos Ricotti, MD, Fellow, Department of Dermatology, Division of Dermatopathology, University of Texas Southwestern School of Medicine
Carlos Ricotti, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, and International Society of Dermatopathology
Disclosure: Nothing to disclose.

Coauthor(s)

Clay J Cockerell, MD, Director, Clinical Professor, Department of Dermatology, Division of Dermatopathology, University of Texas Southwestern Medical Center
Clay J Cockerell, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, International Academy of Pathology, International AIDS Society, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, Society for Investigative Dermatology, and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Mark G Lebwohl, MD, Chairman, Department of Dermatology, Mount Sinai School of Medicine
Mark G Lebwohl, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Abbott Laboratories Honoraria Consulting; Actelion Honoraria Consulting; Amgen Honoraria Consulting; Astellas Honoraria Consulting; Centocor Honoraria Consulting; DermiPsor Honoraria Consulting; Galderma  Consulting; Genentech Honoraria Consulting; Helix BioMedix Honoraria Consulting; Medicis Honoraria Investigator

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Christen M Mowad, MD, Associate Professor, Department of Dermatology, Geisinger Medical Center
Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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