eMedicine Specialties > Dermatology > Papulosquamous Diseases

Psoriasis, Pustular: Follow-up

Author: Elma D Baron, MD, Assistant Professor of Dermatology, Case Western Reserve University, University Hospitals of Cleveland; Director of Skin Study Center, University Hospitals Research Institute; Acting Chief of Dermatology, Veterans Affairs Medical Center, Cleveland
Coauthor(s): Charles R Taylor, MD, Assistant Professor of Dermatology, Harvard Medical School; Director of Phototherapy Unit, Department of Dermatology, Massachusetts General Hospital
Contributor Information and Disclosures

Updated: Jan 16, 2007

Follow-up

Complications

  • Death 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 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 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.
 


More on Psoriasis, Pustular

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Differential Diagnoses & Workup: Psoriasis, Pustular
Treatment & Medication: Psoriasis, Pustular
Follow-up: Psoriasis, Pustular
Multimedia: Psoriasis, Pustular
References
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References

  1. Amin S, Maibach H. Pustular psoriasis: generalized and localized. In: Maibach H, Roenigk HH, eds. Psoriasis. 3rd ed. Marcel Dekker Inc;1998:13-39.

  2. Cassandra M, Conte E, Cortez B. Childhood pustular psoriasis elicited by the streptococcal antigen: a case report and review of the literature. Pediatr Dermatol. Nov-Dec 2003;20(6):506-10. [Medline].

  3. Heng MC, Heng JA, Allen SG. Electron microscopic features in generalized pustular psoriasis. J Invest Dermatol. Aug 1987;89(2):187-91. [Medline].

  4. Honigsmann H, Gschnait F, Konrad K, Wolff K. Photochemotherapy for pustular psoriasis (von Zumbusch). Br J Dermatol. Aug 1977;97(2):119-26. [Medline].

  5. Hubler WR Jr. Lingual lesions of generalized pustular psoriasis. Report of five cases and a review of the literature. J Am Acad Dermatol. Dec 1984;11(6):1069-76. [Medline].

  6. Lee CS, Koo J. A review of acitretin, a systemic retinoid for the treatment of psoriasis. Expert Opin Pharmacother. Aug 2005;6(10):1725-34. [Medline].

  7. Lindgren S, Groth O. Generalized pustular psoriasis. A report on thirteen patients. Acta Derm Venereol. 1976;56(2):139-47. [Medline].

  8. Rosenbaum MM, Roenigk HH Jr. Treatment of generalized pustular psoriasis with etretinate (Ro 10- 9359) and methotrexate. J Am Acad Dermatol. Feb 1984;10(2 Pt 2):357-61. [Medline].

  9. Sauder DN, Steck WD, Bailin PB, Krakauer RS. Lymphocyte kinetics in pustular psoriasis. J Am Acad Dermatol. Apr 1981;4(4):458-60. [Medline].

  10. Toussaint S, Kamino H. Noninfectious erythematous papular and squamous diseases. In: Elder D et al, eds. Lever's Histopathology of the Skin. 8th ed. Lippincott-Raven Publishers:1997.

  11. Umezawa Y, Ozawa A, Kawasima T, et al. Therapeutic guidelines for the treatment of generalized pustular psoriasis (GPP) based on a proposed classification of disease severity. Arch Dermatol Res. Apr 2003;295 Suppl 1:S43-54. [Medline].

  12. Wolska H, Jablonska S, Bounameaux Y. Etretinate in severe psoriasis. Results of double-blind study and maintenance therapy in pustular psoriasis. J Am Acad Dermatol. Dec 1983;9(6):883-9. [Medline].

  13. Zelickson BD, Muller SA. Generalized pustular psoriasis in childhood. Report of thirteen cases. J Am Acad Dermatol. Feb 1991;24(2 Pt 1):186-94. [Medline].

  14. Zelickson BD, Pittelkow MR, Muller SA, Johnson CM. Polymorphonuclear leukocyte chemotaxis in generalized pustular psoriasis. Acta Derm Venereol. 1987;67(4):326-30. [Medline].

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Further Reading

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Keywords

pustular psoriasis

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Contributor Information and Disclosures

Author

Elma D Baron, MD, Assistant Professor of Dermatology, Case Western Reserve University, University Hospitals of Cleveland; Director of Skin Study Center, University Hospitals Research Institute; Acting Chief of Dermatology, Veterans Affairs Medical Center, Cleveland
Elma D Baron, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Photobiology, Photomedicine Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Charles R Taylor, MD, Assistant Professor of Dermatology, Harvard Medical School; Director of Phototherapy Unit, Department of Dermatology, Massachusetts General Hospital
Charles R Taylor, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Laser Medicine and Surgery, Massachusetts Medical Society, and Society for Investigative Dermatology
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; Basilea Honoraria Consulting; Briston-Myers Squibb Honoraria Consulting; Celtic Pharma  Other; Centocor Honoraria Consulting; Chattem Honoraria Other; DermiPsor Honoraria Consulting

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White 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: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

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

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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