What is Pustulosis, Know its Causes, Symptoms, Treatment, Prognosis, Prevention

Pustulosis is a rare autoimmune skin disorder. It is also called as Palmoplantar pustulosis. Pustulosis is characterized by the presence of large fluid filled blisters present on the skin of the palms of hands or soles of the feet. Either one or both the palms/soles are affected. There are intermittent red patchy areas present. The skin is highly inflamed.

The exact cause of pustulosis is not yet known. Pustulosis being an autoimmune disorder, the body’s own immune system produces antibodies which attacks the cells of the sweat glands, thus causing the condition of pustulosis. Some of the probable causes of pustulosis are:

• Habit of smoking
• Pustulosis is found to occur in people suffering from psoriasis
• The administration of TNF-alpha antagonist used for treatment of psoriasis is known to trigger pustulosis in some patients
• Some patients when infected with streptococcal bacteria are found to suffer from pustulosis
• Allergies to certain metals
• History of family members affected with psoriasis or pustulosis.

• Red scaly patches seen in the limited area in people suffering from pustulosis
• There are small yellow pus spots or red brown blisters within the red patches. The blisters and pustules become dry and scaly. In more persistent stages, the skin becomes dry and thickened. There are deep cracks in the skin; it becomes itchy, painful and burning sensation is felt.
• Erythema
• Puritus
• Discomfort while using hands and while walking.

Pustulosis is a rare disorder, hence does not have much incidence. Pustulosis is more commonly seen in females than in males and is not found in children. It occurs in the age range of 40-60 years.

Pustulosis is seen in patients suffering from diabetes mellitus, arthritis, autoimmune thyroid disorders and gluten sensitivity.

As seen in case of many skin related disorders, palmoplantar pustulosis cannot be cured. However, a number of treatments exist to reduce its severity. Topical application creams, tablets and phototherapy help in managing pustulosis.

• Creams and Ointments for Pustulosis
  • Moisturizers: These should be applied several times in a day to prevent dryness and itchiness associated with pustulosis. The use of greasy ointments is more effective in this regard.
  • Steroid Creams: These reduce skin inflammation. They are more effective for pustulosis when used under occlusion.
  • Tar Ointments: Coal tar ointments have been used since many decades for skin problems like pustulosis. They are very effective in healing of blisters and make the skin less itchy. They are mainly used to reduce skin inflammation. Application of coal tar does not allow skin to thicken.
• Acitretin Tablets: These are Vitamin A tablets and are effective in controlling of palmoplantar pustulosis.
• Phototherapy or PUVA Treatment: Light therapy helps to slow down the growth of skin cells and reduces symptoms for long time thus, helping in controlling pustulosis.

The type of treatment to be used depends on the severity of the symptoms of pustulosis seen in the patient. Many a times a patient is advised to use a combination of therapies for treating pustulosis.

Pustulosis is an autoimmune disease. It has an extended course which consists of increase in the number of blisters, while sometimes decrease in their numbers. Pustulosis is not contagious or cancerous. However, pustulosis cannot be cured and affects quality of life which leads to poor prognosis. The person suffering from it experiences difficulty while working with hands and while walking.

The doctor performs the physical examination of the skin and records the medical history. The dermatologist takes the swab of skin to check for presence of fungal or bacterial infections. At times skin biopsy is performed.

Pustulosis cannot be prevented. However one can perform self-care to reduce the severity of symptoms. Self care includes the following:

• One has to quit the habit of smoking.
• Avoid the use of harsh soap, bubble gel and shower gel. Instead one should use moisturizing soap.
• Gloves should be used while performing household work such as cleaning, for manual work such as gardening etc. This prevents irritation caused while working.
• One can even try to use special silk or cotton gloves.
• Use of salicyclic acid or urea creams is recommended to reduce cracking of the thick skin.

Pustulosis affects the quality of life of the person suffering from it. There is lack of data regarding its pathophysiology. Still a lot of research needs to be conducted in this field to understand this skin disorder. In addition, efforts need to be taken to create awareness among the population.