What is Annular Pustular Psoriasis?
Annular pustular psoriasis is a psoriasis variant characterized by unique circular lesions. It is very rare and comprises a very small percentage of all psoriasis cases, a stark contrast to the relative commonality of psoriasis itself. It is primarily a cosmetic difference, although the lesion rings themselves may cover somewhat more area than the psoriasis plaques do.
Other than the circular formation of various lesions, annular pustular psoriasis behaves in the same manner as other psoriasis conditions, specifically pustular psoriasis. It is accompanied by inflammation and redness, itchiness, and thick plaques of the skin which may flake away and may or may not hinder the movement of joints.
Who gets Annular Pustular Psoriasis?
Annular pustular psoriasis is a psoriasis subtype. As consequence, it is most likely to afflict those already at risk for psoriasis. However, annular pustular psoriasis itself is not distinguished from psoriasis vulgaris with respect to risk; that is to say, there are a number of conditions that may put one at greater risk for the development of psoriasis, but few conditions that will lead to annular pustular psoriasis specifically.
The cause of annular pustular psoriasis is linked with the cause of psoriasis itself. Consequently, the cause of annular pustular psoriasis is not completely understood. There are two primary schools of thought surrounding the origin of psoriasis. They do not conflict, but there are nuances that complicate the situation somewhat.
The first school of thought holds that psoriasis (and by proxy, annular pustular psoriasis) is an autoimmune condition. This makes quite a lot of sense. Psoriasis could be seen as the body reacting to threats that do not actually exist, a pattern that would be cogent with the general scheme of autoimmune conditions. This is corroborated by the effectiveness of immunosuppressants; when the immune system is mitigated, individuals suffering from psoriasis frequently have their psoriasis cease its spread and go into remission. This would paint it plainly as an autoimmune condition if it weren’t for a tangle.
The tangle is the correlation between immunocompromised individuals and psoriasis. Individuals suffering from late-stage HIV have a 30% likelihood of developing some form of psoriasis. This accounts for only 1% of all psoriasis cases, but it is still a worthy paradox to observe and question. If psoriasis were a purely autoimmune condition, HIV should effectively serve to slow it down or stop it entirely by destroying the immune system. It certainly shouldn’t trigger a new, original case of it!
A simpler, second school of thought holds that the primary malfunction resulting in psoriasis lies in the keratinocytes of the dermis—that is, the parts of the skin cells responsible for making more skin cells. Should these malfunction and start over-producing, it could easily cause the plaques and various symptoms cogent with psoriasis. However, this requires more testing.
All in all, the primary indicator that an individual is at risk for psoriasis is the presence of an autoimmune condition. This holds true, in turn, with annular pustular psoriasis. Although annular pustular psoriasis cannot be predicted independent of psoriasis, it is still a psoriasis condition, so this correlation still holds true. Furthermore, individuals suffering from late-stage HIV are at great risk, although this will obviously encompass a much smaller percentage of the population (and only about 1% of all cases of psoriasis—and thus very, very few cases of annular pustular psoriasis).
What causes Annular Pustular Psoriasis?
The cause of annular pustular psoriasis has yet to be identified. The two primary theories revolving around the cause of annular pustular psoriasis are that, first and foremost, it is an autoimmune condition, and secondarily that it is brought on by the malfunction of the keratinocytes that are responsible in the body for replacing the skin cells, the hair, the finger and toenails—all keratinous material.
The latter theory is upheld by the simple fact that psoriasis carries symptoms in line with the malfunction of skin replacement. Psoriasis plaques are effectively composed of unnecessary, extraneous skin configured in such a way as to hamper movement and cause discomfort.
The former theory is upheld by the behavior of psoriasis, which is effectively an autoimmune response causing the skin to react to damage that hasn’t actually occurred, but the primary indicator that psoriasis (and annular pustular psoriasis) is autoimmune in nature is that immunosuppressants are an effective form of treatment. When the immune system is mitigated, psoriasis has a tendency to recede and clear up.
This, however, is complicated by the high incidence of psoriasis in immunocompromised individuals. The cause of psoriasis in the immunocompromised is not well understood at all, as any autoimmune nature to psoriasis should be very heavily limited by a destroyed immune system such as that of one suffering from late-stage HIV.
The lack of comprehension surrounding annular pustular psoriasis and psoriasis conditions as a whole is primarily due to limited data. Most of the data surrounding psoriasis conditions and specifically annular pustular psoriasis is collected from hospitals. Individuals in hospitals are already sick, usually for some reason unrelated to their psoriasis—or, in other cases, because their psoriasis condition is so severe as to require hospitalization. This skews the data greatly around individuals that are suffering from extraordinary cases, and there is very little data on individuals who suffer from ‘run-of-the-mill’ psoriasis. Studies are still being conducted, however, as psoriasis is simply too common to ignore and warrants the time.
What does Annular Pustular Psoriasis cause?
Annular pustular psoriasis carries with it all the hallmarks of psoriasis. Among these hallmarks are the formation of plaques, the inflammation of the skin, the formation of pustules, the flaking of the skin, itching of the skin and, in some individuals, a strong psychological impact. Annular pustular psoriasis in particular also carries with it unique lesions. These lesions appear in circular form surrounding the psoriasis plaques, creating something of a spotted appearance.
The plaques caused by annular pustular psoriasis are themselves painless, but their location may be quite problematic. The plaques are stiff and frequently unyielding to the movement of joints. This lack of flexibility can make movement very difficult for individuals suffering from psoriasis, and can effectively become a disability. Individuals with plaques formed near their underarms, for instance, may find that they have great difficulty using their arms in any way that requires extending or stretching them—making lifting, reaching items on shelves, bending over to pick things off the ground and a number of other tasks that would otherwise be mundane painfully impossible. This effect is worst when the plaques form on skin that is otherwise elastic, such as the skin near joints. Plaques near the back of the knees can make walking difficult. Plaques near the neck can make bending one’s head painful. Plaques on the palms of the hands can make typing almost impossible, and plaques on the bottom of the feet can render one unable to walk at all until the psoriasis remits. Annular pustular psoriasis is no exception to this categorization.
The pustules of annular pustular psoriasis can be painful themselves. They are the product of an erroneous immune response, and denote that the body is trying to purge some kind of infection (which may or may not exist). Pustules are small bubbles of pus that form under the skin. These may be quite irritating, although they are not likely to be nearly as painful as plaques can be if they should form in inopportune locations. The pustules leave the skin open to scratching, however, which may lead to infection.
The lesions themselves unique to annular pustular psoriasis are actually fairly benign. They may be inflamed or irritated, but they are not likely to be anymore painful than the pustules if they are in fact painful at all, and aside from their cosmetic impact they do not greatly affect the function of the skin.
Annular pustular psoriasis has a very distinctive look contrasted with psoriasis. This can leave individuals somewhat more self-conscious about their appearance as it is altered by annular pustular psoriasis. While psoriasis itself is fairly common, and its symptoms are unfortunate but easily recognized by many, annular pustular psoriasis has a completely different look that most are not familiar with. This can lead to feelings of alienation and stress that may in some individuals warrant attention.
How serious is Annular Pustular Psoriasis?
Annular pustular psoriasis is a fairly serious condition, as it is chronic. It cannot be cured, and it will not resolve itself on its own. There is nothing that can truly be done to banish it forever with absolute certainty, but it can be held at bay with various treatments. Annular pustular psoriasis is not fatal, however.
Annular pustular psoriasis does carry the risk of certain complications. Most of these are related to the formation of plaques. These plaques may flake away, leaving damaged skin to become infected. They may similarly restrict the motion of appendages and extremities if they should be close to a joint. This can lead to serious disability in some cases (although this disability is usually a temporar inconvenience), as this can prevent an individual from accomplishing otherwise basic tasks simply because they cannot move efficiently. In the most extreme cases of annular pustular psoriasis (and psoriasis in general), the disease may damage the skin’s ability to hold external infections at bay, and may keep the body from regulating its own temperature. This is known as psoriatic erythroderma, and it can be fatal. However, this is an extremely rare complication that only occurs in the most severe cases of psoriasis, and it should be treated as such. Only cases of psoriasis that approach skin involvement in excess of 90% pose any great risk for this condition.
What does Annular Pustular Psoriasis treatment look like?
Treatment for annular pustular psoriasis consists primarily of immunosuppressants. Immunosuppressants have proven effective at forcing psoriasis to go into remission if they are applied aggressively enough. They obviously carry with them a host of risks, but these can be managed, and it is frequently worth it to keep annular pustular psoriasis in check. Immunosuppressants are not a cure, but they can keep breakouts of annular pustular psoriasis from spreading.
Other applicable treatments are primarily symptomatic. Anti-inflammatories may be recommended or prescribed to deal with the formation of pustules. Extreme inflammation may require the use of corticosteroids. If the annular pustular psoriasis is afflicting only a small area, these steroids will likely be administered via injection directly to the affected area. If a higher percentage of the skin is involved, they may be administered orally. This can do much to alleviate the discomfort these pustules may cause.
Moisturizing lotions may be used to soothe the skin, especially near plaques. It is important to specifically look for lotions designed for moisture. Lotions intended primarily for cosmetic purposes will have little to no benefit. In addition to moisturizing lotions used to keep the skin supple, oatmeal baths may help to exfoliate away dying skin and keep itching to a minimum.
How do I know if I have Annular Pustular Psoriasis?
Annular pustular psoriasis is a very distinctive condition. It carries with it all the symptoms of psoriasis, which are fairly obvious, but in addition has the formation of circular lesions. These lesions will circle patches of affected skin and created a unique spotted pattern that could be compared to that of a salamander or other spotted reptile.
Psoriasis itself can otherwise be identified by the inflammation of the skin, the formation of plaques and the subsequent flaking away of the skin. A simple examination is sufficient for a medical professional to diagnose psoriasis and annular pustular psoriasis, but a biopsy can positively confirm this. Any individual suffering from an outbreak of psoriasis or similar symptoms should consult a medical professional as soon as possible. Psoriasis conditions are chronic; they cannot be cured and will not let up. However, they can be kept from progressing and getting exceptionally bad if treatment is begun early and used to keep psoriasis in check before it can become a problem.