How to treat Pustular Psoriasis?
Pustular psoriasis may result in erythroderma. Cutaneous lesions characteristic of psoriasis vulgaris can be present before, during, or after an acute pustular episode, but are not required for diagnosis of pustular psoriasis.
@debangshu There is no criterion standard therapy for pustular psoriasis. Disease severity and extent of skin involvement help guide treatment.
Current recommendations include initiation of systemic medications together with the proper supportive measures. Oral retinoids (acitretin, isotretinoin), methotrexate, cyclosporine, and infliximab are considered first-line therapies by the National Psoriasis Foundation Medical Board. Hydroxyurea and 6-thioguanine have also been used with success. In children, acitretin, cyclosporine, methotrexate, and etanercept are options for first-line therapy; however, no randomized controlled trials exist to confirm efficacy.
Second-line therapies include biologic agents (etanercept, adalimumab, ustekinumab, secukinumab) or topical treatments (corticosteroids, calcipotriene, tacrolimus) for more localized disease on the palms and soles. An example of the palmoplantar condition is seen in the image below. Guidelines regarding these second-line therapies are needed, as anecdotal reports describe paradoxical induction of pustular psoriasis with some biologics.