Edema in psoriasis
Pustular psoriasis is aa relatively rare form of the disease. In recent years, there has been an increase in cases of pustular psoriasis, which is associated with the use of more aggressive therapies (corticosteroid hormones, cytostatics). Pustular psoriasis can develop in people with vulgar psoriasis (60%), or appear immediately in healthy people (40%).
There are generalized and localized formspustular psoriasis. The generalized pustular psoriasis includes the Tsumbush type and the generalized form of persistent pustular acrodermatitis Allopo, as well as exanthematous pustular psoriasis (herpetiform impetigo). To localized forms include: psoriasis with pustulization, which is characterized by the appearance of pustules on the foci of vulgar psoriasis or around them without a tendency to generalization; pustular psoriasis of the palms and soles of Barber; The localized form of persistent pustular acrodermatitis Allopo.
Generalized pustular psoriasis such as Tsumbush
Generalized pustular psoriasis such as Tsumbushmost often occurs in healthy people, but can be in patients with ordinary psoriasis, often exudative or erythrodermic. Characterized by the sudden appearance of widespread, but discrete, hot to the touch erythem, accompanied by burning, which appear small bubbles, quickly transformed into sterile pustules. In some places, the pustules merge into larger foci (lakes). Affected any skin, including the face and scalp, can develop erythroderma. Within a few months the disease has a recurrent character. The course of the disease is accompanied by general reactions (fever, chills, weakness).
Herpetiform impetigo most often occurs inwomen in the second half of pregnancy, can recur during the period of each pregnancy, after childbirth, before menstruation, after a strumectomy (hypoparathyroidism); rarely observed in men and children. The disease appears suddenly, against a background of complete health, without previous psoriasis. Against the background of erythema, sterile, painful strained pustules appear. They arise in groups, can merge with each other, form plaques with eccentric growth and the appearance of figured elements. The process usually begins with the inguinal or umbilical region, the inner surface of the thighs, the area of the mammary glands, neck, occiput, axillary cavities, and then acquire a widespread character. Pustules contain greenish pus, brownish crusts are formed at the dissection. There is no itching in the area of lesions. By their resolution there is no scars and skin pigmentation. Often there is damage to the mucous membranes of the mouth, less often the larynx, esophagus, conjunctiva.
Severe general condition of patients is often accompanied by a fever of a septic type, chills, vomiting, diarrhea, delirium. The disease is flashing.
For the acute period of all clinical formsgeneralized pustular psoriasis is characterized by pronounced skin edema resembling cardiac edema, as well as the appearance of thrombophlebitis. Edema develops suddenly and is associated with impaired permeability of the skin vessels, sometimes irreversible. In this regard, there is a sudden decrease in the volume of plasma, leading to hypotension, tubular necrosis in the kidneys, oliguria and kidney failure. In this case, hemodialysis can save patients. A common symptom is hypocalcemia, combined with hypoalbuminemia, but without signs of tetany.
Patients often have mucosal lesionsshells of the oral cavity and vagina in the form of white annular or polycyclic plaques (such as geographical language). These rashes are characterized by a rapid change in shape; sometimes on the mucous membranes there are erosions, blisters, pustules.
Localized forms of pustular psoriasis.
- Psoriasis with pustulization is characterized by the appearance of pustules on plaques of vulgar psoriasis or around them. The cause of pustulization is irritating external therapy.
- Pustular psoriasis of the palms and soles of the Barber type- a chronically relapsing form of localized pustular psoriasis, sometimes combined with typical vulgar psoriasis. First, vesicles or vesicles-pustules appear on the background of erythema, localized on the arch of the feet and brushes, in the area of the pillows of the fingers. Then there are recurring, as it were drowned in the skin pustules, located at the level of the skin. Drying, the pustules turn into brown, densely sitting crusts, there is atrophy of the skin of the palms and soles.
- Localized persistent pustular acrodermatitis Allopo.
Connection of pustular dermatosis with psoriasisis not recognized by all. The disease is characterized by the appearance of sterile, prone to fusion pustules, which gradually dry out in scaly crusts. A complete resolution of the process is not observed, new pustules are constantly appearing in the same places. The skin becomes atrophic, the osteolysis of the fingertips develops, the nails disappear. The disease is localized only at the fingertips, in mild cases resembles a paronychia.
Pustular psoriasis is characterized by frequent (in 30% of patients) combination of skin lesions with arthritis.
The development of pustular psoriasis can be triggered by the cancellation or reduction of the dose of glucocorticosteroid hormones, pregnancy, stress, and strumectomy. Sometimes the reason remains unknown.