Pustular Psoriasis

Localized

Palmoplantar pustulosis of palms and soles:

• This kind of psoriasis involves the palms and soles, and does not often respond to topical treatment.

The following systemic drugs are listed in order of preference:

• Acitretin +/- topical PUVA
• Methotrexate
• Cyclosporine

Generalized

Pustular Psoriasis (von Zumbusch):

• You need to remove aggravating factors (such as offending drugs and tars) and slowly taper off systemic corticosteroids.
• You will need medical support because of the risk of infection, fluid loss and loss of body heat.
• You should treat an infection with antibiotics.
• You will probably need systemic drugs to effectively treat this type of psoriasis.
• Acitretin is often a doctor's first choice, isotretinoin may be used for younger women
• Cyclosporine and methotrexate will also help