A rare dermatologic emergency

The prevalence of psoriasis in different populations varies from 0.1 percent to 11.8 percent.

The most common variant is known as psoriasis vulgaris. It is a life-long skin disease that is usually seen as red, scaly, itchy plaques on different body parts.

Aside from the skin, patients may also develop pitting, thickening and yellowish changes on their nails, and thick scales on their scalp.

Psoriasis makes patients more prone to develop other diseases later in life, such as psoriatic arthritis, hypertension and heart disease.

That is why even though there is no permanent cure, patients need to be seen by their dermatologists regularly.

Pustular psoriasis is a rare and serious variant of psoriasis. Although infrequently seen, it is imperative that we are aware of this variant since it is considered a medical emergency. Pustular psoriasis can either be localized or generalized. Localized pustular psoriasis may present collections of pus on palms and soles, also known as acrodermatitis continua of Hallopeau or palmoplantar pustulosis.

The generalized types are either acute (von Zumbusch) or subacute, wherein patients present as acutely ill, febrile, with lakes of pus on painful, bright red skin.

Prompt diagnosis is crucial since pustular psoriasis closely resembles other severe skin diseases, such as Staphylococcal scalded skin syndrome (SSSS), Acute Generalized Exanthematous Pustulosis (AGEP), Subcorneal pustular dermatosis (SPD) and Stevens Johnsons syndrome (SJS).

A thorough history of these patients usually reveal on-and-off flares of pustular psoriasis for years.

Usually there is poor follow-up and the patients frequently adjust their own medications that lead to complications.

It is a fact that some medications can trigger a flare of psoriasis, hence, patients must be careful when they are given any of the following: amoxicillin (antibiotic), terbinafine (antifungal), interferon alpha, and tumor necrosis factor alpha inhibitors.

Consequently, withdrawal of some medications may also trigger a flare of pustular psoriasis. Known culprits include corticosteroids, cyclosporine and some biologics.

Various treatments for all forms of psoriasis are currently available at St. Luke’s Medical Center.

Our team of board-certified dermatologists is trained to detect and manage all forms of psoriasis.

Treatment options include topical medications, oral and injectable medications, as well as phototherapy.

St. Luke’s Medical Center offers both narrow-band ultraviolet B and ultraviolet A phototherapy.

The treatments are not without side effects, that is why patients are advised to see their board-certified dermatologists regularly.

PsorPhil is a national support group open for all psoriasis patients and their families. St. Luke’s Medical Center, along with other Philippine Dermatological Society (PDS)-accredited institutions, holds regular PsorPhil gatherings to educate patients on their skin disease.

This is a good venue for exchange of experiences and treatments.

Psoriasis may be untreatable, but definitely manageable with the correct approach and a knowledgeable and caring team of doctors.