Generalized Pustular Psoriasis

What is Generalized Pustular Psoriasis?

Generalized pustular psoriasis is a form of psoriasis characterized by the formation of pustules on the skin. Pustules are raised bumps filled with pus, and signify an immune response. Pustular psoriasis differs from psoriasis vulgaris (the most common form of psoriasis) due to these pustules.

Generalized pustular psoriasis carries with it all the symptoms of psoriasis, including the formation of plaques on the skin and their flaking away. However, affected areas are also afflicted with pustules, which may be painful.

Who gets Generalized Pustular Psoriasis?

Generalized pustular psoriasis is a variant of psoriasis, and as consequence, all of the factors that contribute to who gets psoriasis contribute to who gets generalized pustular psoriasis.

Men and women are equally likely to suffer from generalized pustular psoriasis. Individuals of all ages are equally likely to suffer from generalized pustular psoriasis, however, it tends to grow worse over time. Thus, older individuals suffering from older cases of generalized pustular psoriasis are more likely to suffer more deeply from it. They are similarly more likely to suffer from deeper complications connected to it, and are more likely to have other predisposing factors manifest.

Because autoimmune conditions have a tendency to come in clusters, individuals that suffer from autoimmune conditions are more likely to develop generalized pustular psoriasis. Unfortunately, it would be a gross oversimplification to say that generalized pustular psoriasis is autoimmune; there is a strong link between all forms of autoimmune conditions and psoriasis, but psoriasis is not necessarily an autoimmune condition. This is further reinforced with generalized pustular psoriasis in particular, as pustules are an immune response that are, in the case of generalized pustular psoriasis, erroneous and unneeded.

As an odd contrast to the somewhat autoimmune nature of psoriasis is the prevalence of psoriasis in individuals suffering from late-stage HIV. HIV destroys the immune system, and more than 30% of individuals suffering from late-stage HIV suffer from some form of psoriasis, including generalized pustular psoriasis. Thus, individuals that suffer from late-stage HIV are much more likely to suffer from generalized pustular psoriasis.

What causes Generalized Pustular Psoriasis?

The cause of generalized pustular psoriasis is not fully understood. Like all forms of psoriasis, it falls into an uncanny valley of cause and effect that not much reliable data has been collected on. There are a gestalt of factors in play, and much of the data revolving around psoriasis and generalized pustular psoriasis comes from individuals that are hospitalized at the time. This skewing of the sample makes the data less useful.

The initial response of many is to assume or claim that psoriasis is an autoimmune condition. There is a lot of momentum behind this theory. The primary factor in this theory is that psoriasis has a tendency to remit when immunosuppressant drugs are administered. This would seem to imply that psoriasis is purely caused by a defective immune response—the very definition of an autoimmune condition. It follows that this makes sense; the body would be responding to the perception of damage that was not actually happening, resulting in the buildup of excess skin cells and the consequential scaling of the skin in the form of plaques.

However, there is also a strong likelihood that there is a malfunction of the skin’s keratinocytes. Keratinocytes are partially responsible for the creation of new skin cells. Consequently, their malfunction en masse could lead to the creation of extraneous skin cells that would result in the formation of skin plaques.

More puzzling is the correlation between psoriasis and immunocompromised individuals, specifically those suffering from late-stage HIV. More than 30% of individuals suffering from late-stage HIV develop some form of psoriasis, including generalized pustular psoriasis (HIV-related cases of psoriasis comprise about 1% of all psoriasis conditions). This is paradoxical due to the apparent autoimmune nature of psoriasis and the immunocompromised nature of HIV patients. Because immunosuppressants are effective in holding back the spread of psoriasis plaques, it follows that having a crippled immune system should correlate to the remission of psoriasis plaques, not their formation. However, this is not the case.

Aside from a definitive autoimmune link (although not necessarily a direct connection), the exact cause of psoriasis is not fully understood. Generalized pustular psoriasis, specifically, certainly has an autoimmune component as evidenced by the presence of pustules.

What does Generalized Pustular Psoriasis cause?

Generalized pustular psoriasis follows the profile of psoriasis in terms of its effects. That is, it results in plaques forming over a certain percentage of the skin. Generalized pustular psoriasis is different because it also results in the formation of pustules. Pustules are raised bubbles of pus on the skin, and denote an immune response. They are very similar to blisters, and can be painful.

When psoriasis plaques like those caused by generalized pustular psoriasis appear on or near joints or other skin generally intended to be elastic, the condition can be quite debilitating. Psoriasis plaques on the hands can make it difficult to handle a pen or type. Psoriasis plaques on the knees can make walking difficult, if not painfully impossible, and psoriasis plaques on the elbows or near the underarms can severely limit the mobility of one’s arms. This is perhaps the greatest risk posed by psoriasis.

Psoriasis outbreaks on the face can be quite demoralizing for their effect on one’s appearance, as the raised nature of the plaques makes them very difficult to disguise with cosmetics. The only real hope for someone in this situation is to bide time until the psoriasis remits, but this is not always predictable.

Generalized pustular psoriasis is unique for having pustules. These pustules can significantly contribute to the irritation one feels in the skin. They may lead the skin to be redder and may be painful to the touch. Their rupture should the skin be abrased may result in a greater vulnerability to cutaneous infection than would be suffered otherwise.

How serious is Generalized Pustular Psoriasis?

Generalized pustular psoriasis is a serious condition, but it is not fatal. It has the potential to constitute a very serious disability, but it will not necessarily. Most cases of generalized pustular psoriasis are purely cosmetic and serve to be a nuisance at worst. However, it is possible for cases of generalized pustular psoriasis to grow significantly worse if left unchecked. It is consequently important to seek treatment for generalized pustular psoriasis to keep the symptoms in check.

Plaques near skin that generally must be elastic, such as the neck and on the inside of joints, can be very debilitating. The skin in these areas is elastic to facilitate ease of movement. The removal of this elasticity due to the plaques makes movement very painful, if not impossible, and can greatly limit the range of motion in nearly any joint. Generalized pustular psoriasis necessarily may spread to any point of the body, meaning this could hypothetically lock down any individual joint or any combination of appendages if it should grow severely enough.

What does Generalized Pustular Psoriasis treatment look like?

Treatment for generalized pustular psoriasis consists primarily of symptomatic treatment. Because the cause of generalized pustular psoriasis is not fully understood, it is impossible to treat it ‘at the root’, as it were. However, much can be done to diminish the difficulty posed by the plaques.

A moisturizing lotion can do quite a bit to keep the plaques pliable. This can help greatly if the plaques should be restricting motion, such as when they form near joints. It may also prevent some of the itching that is likely to occur due to the dryness of the skin and the stiff nature of the plaques.

The most effective treatment for generalized pustular psoriasis is usually an immunosuppressant. Immunosuppressants have been demonstrated time and time again to prevent the onset of further psoriasis plaques and can force psoriasis into remission. However, immunosuppressants (naturally) lower the body’s natural immunities to various infections. Individuals taking immunosuppressants are frequently rendered more vulnerable to infections of all kinds, including viral ailments and bacterial infections.

Various anti-inflammatories may be effective in reducing the inflammation surrounding plaques and affected skin. These may also aid in the resolution of clusters of pustules in generalized pustular psoriasis.

How do I know if I have Generalized Pustular Psoriasis?

Generalized pustular psoriasis can be identified easily by the symptoms of psoriasis accompanied by the formation of pustules. Psoriasis consists of stiff plaques forming on the skin. These plaques are frequently quite itchy and painful, and may flake away like dead skin if scratched at. Pustules are tiny blisters of pus that form on the skin, and are easy to identify. The formation of the two combined denotes generalized pustular psoriasis. However, self-diagnosis is never a good option for any health condition. Anyone that suspects they are suffering from psoriasis is best served by talking to a medical professional at their earliest convenience. Early and aggressive treatment can prevent psoriasis from becoming more of a hindrance than it needs to be. Psoriasis cannot be cured; it is a chronic condition that will not simply go away. However, it can be forced to remit.

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