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Section 3 Psoriasis and Psoriasiform Dermatoses 57
Figure 3-12. Palmar pustulosis Creamy-yellow pustules that are partially confluent
on the palm of a 28-year-old female. Pustules are sterile and pruritic, and when they
get larger, become painful. At the time of this eruption, there was no other evidence of
psoriasis anywhere else on the body, but 2 years later the patient developed chronic
stable plaque psoriasis on the trunk.
Generalized Acute Pustular Psoriasis (Von Zumbusch)
ICD-9: 696.1 ° ICD-10: L40.1
■ A rare life-threatening medical problem with
abrupt onset.
■ Burning, fiery-red erythema topped by pinpoint
sterile yellow pustules in clusters spreading within
hours over entire body. Coalescing lesions form
“lakes” of pus (Fig. 3-13). Easily wiped off.
■ Waves of pustules follow each other.
■ Fever, malaise, and leukocytosis.
■ Symptoms: burning, painful; patient appears
frightened.
■ Onycholysis and shedding of nails; hair loss of
the telogen defluvium type (see Section 33), 2–3
months later; circinate desquamation of tongue.
■ Pathogenesis unknown. Fever and leukocytosis
result from release of cytokines and chemokines
into circulation.
■ ○
■ Differential diagnosis: pustular drug eruption (see
Section 23); generalized HSV infection.
■ May follow, evolve, or be followed by psoriasis
vulgaris.
■ Special types: Impetigo herpetiformis: generalized
pustular psoriasis in pregnant woman with
hypocalcemia. Annular type: in children with
less constitutional symptoms (Fig. 3-14A).
Psoriasis cum pustulatione (psoriasis vulgaris with
pustulation: In maltreated psoriasis vulgaris. No
constitutional symptoms. Acrodermatitis continua
of Hallopeau: Chronic recurrent pustulation of nail
folds, nail beds, and distal fingers leading to nail
loss (Fig. 3-14B). Occurs alone or with generalized
pustular psoriasis.