Pustular psoriasis
Introduction
Introduction to pustular psoriasis Pustular pustule is a localized epithelial cavity bulge containing turbid pus. It originated from the skin and evolved from papular blisters. Pustules vary in size, and there may be inflammatory redness around them. After the shallow pustules dry up, they become purulent and leave no scars. The pustules can form ulcers and leave scars. In terms of treatment, you can use Ou Qi Beikang first, and the effect is good. In addition, the disease can be divided into two types, one is limited, and the other is generalized. Pseudotype psoriasis is rarer than red-skin psoriasis, and its condition is more serious and the treatment is more difficult. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: Eczema
Cause
Causes of pustular psoriasis
Drug factor (30%)
In recent years, cases of generalized pustular psoriasis have increased due to the irregular use of corticosteroids in the treatment of psoriasis vulgaris. Such as long-term use of topical glucocorticoids, salicylic acid drugs, etc., can lead to autoimmune system disorders, induced the disease.
Streptococcal infection (15%)
Clinical statistics show that the disease occurs after infection with the upper respiratory tract streptococci, so it is thought to be related to the infection. But not directly infected the skin, but an abnormal reaction of the body. In addition, the pustules are not the same as pustules that are actually infected with bacteria. Pustules of bacterial infection are large, isolated, scattered, relatively superficial, easy to smash, purulent on the surface, clinically common in children with impetigo. The aseptic pustules of pustular psoriasis are small, densely distributed, deep, and it is not easy to form a smashed surface, and the pustules have desquamation after dryness.
Other factors (20%)
Some scholars have proposed that the disease is also related to genetic factors, mental stimulation, metabolic disorders, endocrine disorders and climate change.
Prevention
Pustular psoriasis prevention
The treatment of pustular psoriasis should comprehensively analyze the condition and disease, remove possible predisposing factors, avoid the simple pursuit of short-term efficacy, neglect the side effects and long-term effects of drugs, and pay attention to the complementarity between local and systemic treatment. Because pustular psoriasis is a more serious type of psoriasis, the pathogenesis is more complicated, and there are more predisposing factors, especially in recent years, due to the irregular application of corticosteroids in the treatment of psoriasis vulgaris. There is an increasing trend in cases of generalized pustular psoriasis. This type of psoriasis has a long course, and the treatment lacks a single dose of the drug. Although the combination can control the disease, it is easy to relapse after stopping the drug, especially the treatment of psoriasis psoriasis.
1, recognize the nature of the disease, pay attention to the identification of signs
The damage is aseptic pustules, caused by non-bacterial infections, but antibiotics such as chloramphenicol and erythromycin are effective in relieving the disease. Patients with acute rash and generalized pustular psoriasis are often accompanied by systemic symptoms such as chills, fever, joint pain and so on. Should pay attention to rest, avoid fatigue, and strengthen supportive therapy. Also pay attention to the identification of signs and accompanying symptoms and other diseases.
2, strengthen care, avoid stimulation
In the acute rash period or course of disease, about 26% of cases have joint symptoms, 15% of cases have mucosal damage, 52% of cases refer to (toe) nail involvement, and the treatment of these affected parts should be strengthened during treatment to prevent joint damage and deformity. Avoid drug stimulation to make the condition worse. When bathing, disable hot water scalding, rubbing and soapy water to stimulate skin lesions to prevent secondary infection.
3, the correct choice of drugs, to avoid aggravating the disease
Patients with pus-type psoriasis should avoid the use of drugs that may aggravate their condition, such as chloroquine, phenylbutazone, and arsenic. In the treatment of combined joint symptoms, the use of drugs that may aggravate psoriasis vulgaris should be avoided, such as oral indomethacin, intra-articular injection of phenylbutazone. Systemic application of corticosteroids and immunosuppressants should strictly control the indications, closely observe the changes in the condition, and gradually reduce the amount after symptom control and maintain the treatment with a minimum effective amount for a period of time to avoid recurrence caused by sudden withdrawal or excessive reduction.
4, grasp the changes in the condition, pay attention to prevention and treatment
Pustular psoriasis is developed on the basis of psoriasis vulgaris. During the treatment, pustules often resolve faster than the psoriasis vulgaris. When continuing to treat psoriasis vulgaris, Avoid using high-concentration, irritating topical drugs and hot water to prevent pustule recurrence. Younger patients with psoriasis are pustular at first, and the condition tends to progress slowly. The treatment effect is better. The pustules can quickly subside. After disappearing, psoriasis vulgaris lesions can occur, and pustules are less. relapse. Pustules occur repeatedly or develop from psoriasis vulgaris, the disease progresses rapidly, the treatment effect is poor, pustules last longer, and relapse easily after regression. Therefore, when selecting drugs, comprehensive analysis of the condition, objective evaluation of drug efficacy, accurate judgment of prognosis, and prevention and treatment.
Complication
Pustular psoriasis complications Complications eczema
Chronic eczema.
Symptom
Pustular psoriasis symptoms Common symptoms Spleen ESR increases fasting Pustular joint swelling and heat
Symptoms and signs
1. Generalized pustular psoriasis
Most of the acute onset can spread throughout the body within a few weeks, often accompanied by high fever, joint pain and swelling, general malaise and increased white blood cells, erythrocyte sedimentation rate and other systemic symptoms, and intensive needles to miliary lesions The small aseptic small pustules are covered with atypical psoriasis scales. Afterwards, the pustules rapidly increase into large pieces or become ring-shaped erythema, and the margins often have more small pustules. It can be rash all over the body, but it is more common in the flexion and wrinkles of the limbs. There are also those who first rash from the palm of their hand and then extend to the whole body. In some cases, some patients are rapidly reddened and swollen in the short term, and numerous sterile small pustules appear. The pustules dry up and desquamate after a few days, but new pustules can be renewed underneath. Often due to external factors such as friction, the pustules are ruptured, and skin lesions such as erosion, exudation, scarring or purulent sputum appear. Oral buccal mucosa may also cluster or mostly scattered in small pustules, nails may atrophy, chipping or dissolving, some decks are thick and turbid, and there are layers of scales under the deck, and nail beds may also appear. Small pustules. Patients often have gully tongues. After the condition is relieved, psoriasis vulgaris lesions can occur. The course of the disease can be several months or longer, and most of them are recurrent and recurrent, and can also develop into erythroderma. It can often be complicated by liver and kidney damage, and can be life-threatening due to secondary infection, electrolyte imbalance or failure.
2, palmoplantate pustular psoriasis
Skin lesions are limited to the hands and feet, mostly in the palm of the hand, but also extend to the back of the finger (toe), often occurring symmetrically. The damage is symmetrical erythema. There are many aseptic pustules on the plaque to the size of the miliary. The blister wall is not easy to rupture. After about 1-2 weeks, it can dry up and brown. After the sputum is detached, small scales may appear. After the scales are removed, small bleeding spots may occur. Later, new groups of new pustules may appear under the scales, so that lesions of different periods such as pustules and scars may be seen on the same patch. . There are pain and itching in the skin lesions. The nails are also often invaded, resulting in deformation, turbidity, hypertrophy, and irregular ridges. In severe cases, pus can accumulate under the arm. Psoriasis lesions are often seen in other parts of the body. Often accompanied by a grooved tongue. The patient is generally in good condition and may be accompanied by symptoms such as low fever, headache, loss of appetite and general malaise. The condition is stubborn, recurrent, and poor response to general treatment.
Examine
Examination of pustular psoriasis
1, scrape off the scales can appear translucent film, some people called the film phenomenon. Peeling of the film occurs as a point-like hemorrhage called Auspitz's sign. The membrane phenomenon is specific to the diagnosis of psoriasis by the Auspitz sign.
2. If necessary, perform skin biopsy and X-ray examination of the joints, and the joints have an inflammatory reaction. X-ray shows that some patients have the same joint changes as rheumatoid arthritis. The bone may have local decalcification, narrow joint space, and different degrees of joint erosion and soft tissue swelling.
3, blood routine test shows an increase in the number of white blood cells.
Diagnosis
Diagnosis and diagnosis of pustular psoriasis
diagnosis
Characteristics of localized pustular psoriasis:
1, mostly limited to palm sputum, often in the large and small fish or foot and ankle in the majority of light yellow needles to miliary size pustules, base flushing.
2, about 1 to 2 weeks of pustule rupture, crusting, desquamation. Later, small pustules appeared under the scales, which were light and heavy.
3. Self-itching or pain. Sometimes there may be low fever or general malaise, nails are often involved, turbid and thick, with a ridge-like bulge.
4. Psoriasis lesions are often seen in other parts of the patient's body.
5, some patients first in the palm of the hand, after repeated episodes, turned into a generalized.
Characteristics of the onset of generalized pustular psoriasis:
1, mostly for acute onset, pustules can be spread throughout the body for several days to several weeks, the first small pustules with dense needle tip size, and soon merge into a pus.
2, rash can be found throughout the body, but the folds and limbs are more common. Sometimes a small pustule can appear on the nail bed, and the deck is thick and turbid.
3, often accompanied by high fever, joint swelling and pain and general malaise, blood routine tests showed increased white blood cell count.
4, after the pustules dry up, immediately remove the dandruff, and the dandruff will be followed by a new small pustule; the course of the disease can be repeated for several months or more.
In the diagnosis, the difference between the two is mainly generalized with fever, general malaise and other systemic symptoms, easy to secondary erythroderma, etc., and the limitations are generally not.
Differential diagnosis
Determine the type (normal, erythrodermic, pustular or arthritic) and the stage (onset, stationary or retrograde). Pay attention to the identification of seborrheic dermatitis, pityriasis rosea and continuous acral dermatitis.
