Pustular Dermatitis: Causes, Symptoms, and Treatment Options

Pustular psoriasis

I have developed blisters and pustules on both my palms and soles, especially on the soles where the skin surface has thickened.
The inner layer has yellow pustules that sometimes itch.
When the thick skin is peeled off, it reveals pits and cracks that are very painful.
My fingernails have also thickened and turned black, appearing uneven, similar to a fungal infection.
I have sought medical attention and after examinations, it was determined that there is no fungal infection (nail debris was tested).
A biopsy was taken from the blisters on my palms (the wound was stitched with three stitches), and the results indicated pustular disease.
The ointment prescribed by the doctor (Dexamethasone) has not improved my condition.
This issue is distressing, causing pain and itching that disrupts my sleep.
I have lost interest in work and my self-confidence has diminished, leading to feelings of inferiority.
I am also concerned that this long-term condition may lead to depression.
I sincerely hope you can provide me with new medical information.
Is there medication available? Or should I consider other treatment options? (I have consulted numerous doctors, most of whom say it will not improve).
Thank you for taking the time to read my inquiry!

Wensirou, 40~49 year old female. Ask Date: 2005/06/10

Dr. Jiang Zheen reply Dermatology

I'm not sure if your pustular condition is pustular psoriasis.
There is a type of psoriasis that affects the palms and soles, which is a rather difficult skin condition to treat, as psoriasis itself is a chronic disease that is hard to eradicate.
However, there are many treatment options available, including topical vitamin D, topical retinoids, and topical immunosuppressants (such as Protopic) that you can try.
If you live in Taipei, you can consult Dr.
Tsai Cheng-Fang at National Taiwan University Hospital, who is an expert in this area.
If you are in the southern part of Taiwan, you can visit Dr.
Hsu Ming-Lung at Cheng Kung University Hospital for consultation.
Wishing you peace, and may the love of Jesus be with you always.

Reply Date: 2005/06/10

More Info

Pustular dermatitis, often characterized by the presence of pustules or blisters filled with pus, can be a challenging condition to manage. It can manifest on various parts of the body, including the palms and soles, as you described. The symptoms you are experiencing, such as thickened skin, painful fissures, and changes in your nails, suggest a more complex dermatological issue that may require a multifaceted approach to treatment.

Causes of Pustular Dermatitis
Pustular dermatitis can arise from various causes, including:
1. Infections: While you mentioned that fungal infections were ruled out, bacterial infections can also lead to pustular lesions. Conditions like folliculitis or secondary infections from skin breakdown can contribute to pustular dermatitis.

2. Autoimmune Disorders: Certain autoimmune conditions, such as psoriasis or pustular psoriasis, can cause pustular eruptions. These conditions often require systemic treatment rather than topical therapies.

3. Allergic Reactions: Contact dermatitis due to allergens or irritants can lead to pustular reactions, particularly if the skin barrier is compromised.

4. Environmental Factors: Excessive sweating, friction, or exposure to irritants can exacerbate skin conditions, leading to pustular formations.

5. Genetic Predisposition: Some individuals may have a genetic tendency toward skin conditions that manifest as pustular dermatitis.

Symptoms
The symptoms you described, including itching, pain, and the presence of yellow pustules, are common in pustular dermatitis. The thickened skin and nail changes you mentioned could indicate a chronic condition that has been exacerbated by scratching or secondary infections.

Treatment Options
1. Topical Treatments: While you have tried a topical medication (Dai Mo Fu), it may be beneficial to explore other options. Corticosteroids can help reduce inflammation, while topical antibiotics may be necessary if there is a secondary bacterial infection.

2. Systemic Medications: If topical treatments are ineffective, systemic medications such as oral corticosteroids or immunosuppressants may be considered, especially if an autoimmune component is suspected.

3. Moisturizers and Barrier Repair: Regularly applying emollients can help restore the skin barrier and reduce dryness and irritation. Look for products that are fragrance-free and designed for sensitive skin.

4. Phototherapy: In some cases, light therapy can be effective in treating pustular dermatitis, particularly if it is related to psoriasis.

5. Lifestyle Modifications: Avoiding known irritants, wearing breathable fabrics, and managing stress can also help improve your skin condition.

Psychological Impact
It’s understandable that dealing with a chronic skin condition can lead to feelings of self-consciousness and even depression. It’s important to address these feelings, as mental health is a crucial aspect of overall well-being. Consider speaking with a mental health professional who can help you cope with the emotional challenges of living with a chronic skin condition.

Seeking Further Help
Given that you have consulted multiple physicians without satisfactory results, it may be worthwhile to seek a referral to a dermatologist who specializes in complex skin disorders. They may offer new insights or treatment options that have not yet been explored.

In summary, pustular dermatitis can be a complex condition requiring a comprehensive approach to treatment. It’s essential to work closely with a healthcare provider to develop a tailored treatment plan that addresses both the physical and emotional aspects of your condition.

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