Plaque psoriasis (psoriasis vulgaris)
Psoriasis in its most common form shows as plaque, which affects some 80% of all sufferers, revealing itself as raised, reddened lesions covered in scale. Although it may appear anywhere, it usually occurs on the scalp, elbows, knees and back as small red spots which grow into the characteristic plaque patches. These then develop scale which is constantly produced and dropped.
Psoriasis frequently produces itching, skin cracking and pain and the skin becomes dry.

Pustular psoriasis
Pustular psoriasis mainly affects adults and can arrive as the first indication of psoriasis. Equally, plaque psoriasis can evolve into pustular psoriasis. It can be set off by a number of things from usage of medications to medication withdrawal, to steroid usage, to pregnancy.

White, pus-filled blisters form and are surrounded by the characteristic reddened skin. The pus is neither contagious nor infectious and is simply white blood cells. A very small percentage of sufferers get this form – less than 5% - and it is usually confined to specific areas although it can appear all over the body. It normally goes through a series of phases – the usual skin reddening starts the process, then pustules form and finally scaling takes place.

A number of forms of pustular psoriasis occur and although its manifestation and process can vary greatly in different individuals, it can be alleviated.


Forms of pustular psoriasis

Palmo-plantar pustulosis (PPP)
Palmo-plantar pustulosis normally afflicts adults from the 20s to the 60s. As its name suggests, it appears on the palms of the hands and the soles of the feet. Although the precise cause is unknown, stress and possibly other infections are suspected to set it off. Men tend to suffer from this form less than women.

Palmo-plantar pustulosis presents as large numbers of small pustules (approx 5 – 6mm in diameter) on the hands and feet – around the more fleshy areas. It develops in cycles as described above.
There is some evidence to suggest that some smokers’ reaction to nicotine may trigger this form of psoriasis so it is suggested that if possible smokers should quit,
It is always worth using topically applied treatments at first and only proceeding to other treatments if this has no affect.

Von Zumbusch
Von Zumbusch pustular psoriasis can be set off by a number of causes of the type mentioned above under “Pustular Psoriasis” and can appear very rapidly.
The skin becomes very sensitive and painful in the many areas where reddening originally occurs, and this is rapidly followed by the arrival of pustules. Within usually 48 hours or less the pustules become dry, peel and the skin is left very smooth. The process can then repeat itself often lasting days and even weeks.

Sufferers from von Zumbusch pustular psoriasis frequently need to go to hospital as a result of loss of body moisture which must be replenished. A number of treatments are available.
This form of psoriasis (von Zumbusch) is seldom seen in children, and they have a better chance of successful treatment than adults. Nevertheless they should be taken to the doctor as soon as it is discovered or suspected. Children can withstand dehydration of the body’s tissues even less than adults.

Sufferers from normal plaque psoriasis sometimes develop repetitive attacks of von Zumbusch which can cause chills, serious itching, fever, pulse increase, dehydration and other severe effects. It must be treated medically immediately as it can prove fatal. Go to your doctor at once, and if that is not possible attend your local hospital’s Out Patients Department. No risks should be taken since the heart and kidneys maybe affected of left untreated for too long.

Acropustulosis (acrodermatitis continua of Hallopeau)
Acropustulosis is not at all common and appears on the tips of the fingers and/or toes, frequently appearing after an injury to the area – a cut, graze, infection or the like. It can be painful and affect the conformation of the nails, whilst in some serious cases it can deform bone. It is a form which is difficult to treat although covered topically applied treatments can be helpful whilst in other cases ingested treatments work better.