Generalised Pustular Psoriasis Flashcards
What is generalised pustular psoriasis?
An extremely rare type of psoriasis that can present in a variety of forms
What does generalised pustular psoriasis require?
Emergency hospital referral
What age groups can generalised pustular psoriasis present in?
Any but rarer in younger children
What do most cases of generalised pustular psoriasis occur alongside?
Existing prior psoriasis conditions
What are some recognised triggers for generalised pustular psoriasis?
- Systemic steroid withdrawal
- Drugs
- Topical medications causing irritation
- Infections
- Sunlight or phototherapy
- Cholestatic jaundice
- Hypocalcaemia
What drugs can cause generalised pustular psoriasis?
- Salicylates
- Lithium
- Penicillin
- Hydroxychloroquine
What topical medications can cause generalised pustular psoriasis?
- Coal tar
- Steroids under occlusive dressing
- Anthralin
How does generalised pustular psoriasis first present?
Red and tender skin with clusters of pustules appearing within hours
Describe the lesions in generalised pustular psoriasis?
Multiple small (2-3mm) yellowish pustules develop in an erythematous background and may spread to a generalised pattern
What happens to generalised pustular psoriasis lesions over 24 hours?
The pustules coalesce, dry and desquamate in sheets
What areas are most commonly affected in generalised pustular psoriasis?
Flexural and anogenital regions
Where may pustules also appear in generalised pustular psoriasis?
On the tongue and under the nails
What can pustules on the tongue cause in generalised pustular psoriasis?
Dysphagia
What can pustules under the nails cause in generalised pustular psoriasis?
Loss of nails
What are the systemic symptoms of generalised pustular psoriasis?
- Headache
- Fever
- Chills
- Arthralgia
- Malaise
- Anorexia
- Nausea
What are the investigations for generalised pustular psoriasis?
- FBC
- Elevated Inflammatory markers
- Hypoalbuminaemia
- Abnormal LFTs
- No microbial growth from cultures of pustules or blood
What will an FBC show in generalised pustular psoriasis?
- Raised WCC
- Marked rise in neutrophils
- Fall in lymphocytes
What are the differentials for generalised pustular psoriasis?
- Drug eruptions
- Sepsis
- Palmoplantar pustulosis
What is palmoplantar pustulosis?
A localised form of pustular psoriasis
When should patients with generalised pustular psoriasis be admitted to hospital?
Immediately, it is a life threatening emergency 🚨
What supportive therapy is needed in generalised pustular psoriasis?
- Hydration
- Fluid and electrolyte balance
- Nutrition
- Temperature regulation
What can assist in soothing and debriding areas affected by generalised pustular psoriasis?
Bland topical compress or saline or oatmeal baths
What specific medications can be useful in generalised pustular psoriasis?
- Oral retinoids
- Systemic corticosteroids
- Methotrexate
- Ciclosporin
- Colchicine
- Biological therapies
What are the potential complications of generalised pustular psoriasis?
- Secondary bacterial infection of the skin
- Nail loss
- Hypoalbuminaemia
- Renal tubular necrosis
- Liver damage
- Malabsorption and malnutrition
- Death
