Psoriasis vulgaris cum pustulatione L40.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Definition
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Intermittent occurrence of a mostly temporary, eruptive pustule in the area of already (longer) existing foci in psoriasis vulgaris. Pustule episodes can be accompanied by disturbances of the general condition up to fever.

Clinical features
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  • Few to numerous, localized or disseminated, mostly symmetrically distributed, scaly, differently elevated (infiltrated), red, sharply defined plaques of varying size (0.5cm to 10.0cm and >) and configuration (roundish or oval, map-like). Around the plaques varying numbers of white or grey-white, differently sized, vulnerable and easily bursting pustules, which usually develop within a few days. With confluent formation of weeping areas.
  • Auspitz phenomenon can be triggered in the (pre-existing) psoriatic plaques.
  • There is usually a high endogenous eruption pressure.
  • Shear-like progression with different shear frequencies is characteristic.
  • see also overview chapter Psoriasis

Laboratory
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Increased inflammation parameters (CRP, BSG); neutrophil leukocytosis;

Histology
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S.u. Psoriasis vulgaris. Additionally spongiform pustules with neutrophil leucocytes.

External therapy
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  • Initially, use dithranol only in low concentrations and increase the concentration very slowly (s.a. psoriasis vulgaris). Accompanying daily brine baths and tar baths are also possible (e.g. Balneum Hermal with tar). If necessary, use in combination with UVB. Increase UV doses very carefully. Avoid Dermatitis solaris under all circumstances.
  • Alternative: Short-term external application of glucocorticoids, especially in case of fresh attacks. Pustules disappear after hours or days. After stopping the pustular flush, change to the classic external therapy scheme. Caution! Avoid irritating external agents!

Notice! The push activity is usually limited in time. Therefore the focus of the therapy has to be put on external measures!

Internal therapy
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Systemic therapy according to psoriasis vulgaris. In addition to retinoids, fumaric acid esters or methotrexate have also proved successful. In case of resistance to therapy, a combination of methotrexate and fumaric acid esters would be possible under strict control of laboratory values and immune status.

Progression/forecast
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The pustules disappear after hours or days.

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020