Acropustulosis and pustular psoriasis

In pustular psoriasis and acrodermatitis continua (Hallopeau's disease), involvement of a single digit is common. It is often misdiagnosed when the pustule appears beneath the nail plate with necrosis of tissue resulting in desiccation and crust formation. New pustule formation may develop at the periphery or within the lesions. The nail is lifted off by the crust and lakes of pus and new pustules may form on the denuded nail bed (Figures 5.425.44). Permanent loss is possible. Acral pustular psoriasis has been reported with resorptive osteolysis ('deep Koebner phenomenon') and pronounced skin and subcutaneous tissue atrophy. There may be progressive loss of entire digits in the feet and loss of finger tips and finger nails. 'Tuft' osteolysis may occur independently of acropustuloses and arthritis. Histopathology reveals Munro-Sabouraud 'micro-abscesses' or the spongiform pustule of Kogoj. Localized psoralens with ultraviolet irradication (PUVA) therapy can be of benefit. Oral retinoid therapy may give good short-term results, but recurrences appear 1-3 months after the treatment has been stopped. Combined retinoid and PUVA treatment delays and lowers the frequency of relapses. Topical mechlorethamine has given some good results, as has intramuscular triamcinolone acetonide.

The differential diagnosis of acropustulosis may be controversial, particularly with regard to the subcorneal pustular dermatosis of Sneddon and Wilkinson. Many authorities have described patients with pustular lesions like those described as subcorneal pustular dermatosis, but who had in addition stigmata suggestive of psoriasis. These included typical scaly plaques on the elbows and knees, pitted nails or arthropathy. It is, however, pointless to debate the pathogenesis of Sneddon-Wilkinson disease without applying the techniques available for identifying the psoriatic state: cell kinetics, complement activation in the stratum corneum, human leucocyte antigen (HLA) family studies and nail growth studies.

Hallopeau Acropustulosis

Figure 5.42

Psoriatic acropustulosis (Hallopeau's disease).

Figure 5.42

Psoriatic acropustulosis (Hallopeau's disease).

Acropustulosis Psoriasis

Figure 5.43

Pustular psoriasis.

Psoriasis Nail Fold

Figure 5.44

Proximal nail fold pustular psoriasis—limited form of acropustulosis. Reiter's syndrome

The clinical and histological features of the skin changes in Reiter's syndrome may be indistinguishable from those of psoriasis. Skin changes resembling paronychia can accompany nail

Figure 5.44

Proximal nail fold pustular psoriasis—limited form of acropustulosis. Reiter's syndrome

The clinical and histological features of the skin changes in Reiter's syndrome may be indistinguishable from those of psoriasis. Skin changes resembling paronychia can accompany nail

Was this article helpful?

0 0
Natural Arthritis Pain Remedies

Natural Arthritis Pain Remedies

It's time for a change. Finally A Way to Get Pain Relief for Your Arthritis Without Possibly Risking Your Health in the Process. You may not be aware of this, but taking prescription drugs to get relief for your Arthritis Pain is not the only solution. There are alternative pain relief treatments available.

Get My Free Ebook


Post a comment