| • | AKA pustular psoriasis of the Barber type |
| • | associated in some patients with psoriasis elsewhere on the body |
| • | pustular bacterid – controversy over whether this should be considered a distinct entity from PPP |
| • | clinically and histologically identical to PPP |
| • | foci of bacterial infection usually quoted as being teeth and tonsils, but evidence for the pathogenic role of bacteria is scarce |
| • | absence of other signs of psoriasis |
clinical:
| • | groups of small pustules (1-3mm ) of » equal size and symmetry on erythematous skin |
| • | usually both feet and both hands |
| • | as pustules become older, their yellow color changes to dark brown |
ddx:
| • | pompholyx – onset is also acute, but vesicles are clear (unless superinfected) and of various sizes, and interdigital distribution is more prominent |
| • | tinea – rarely shows pustules of equal size and symmetry |
treatment:
| • | difficult: PUVA, antipsoriatic remedies: dithranol, methotrexate, soriatane |
| • | PO steroids not recommended (rebound as in other forms of psoriasis) |
| • | try tetracycline 500PO QID and topical steroids under occlusion |
|