A case of non-infective pustules

When you see pustules like this on a red base you usually think of an infective cause, particularly herpes simplex if the pustules are grouped, and staph folliculitis when associated with the hair follicles.

However, pustules can be a marker of inflammation rather than infection. The neutrophilic disorder Sweet’s syndrome is one inflammatory pustular disorder to consider but this is another. It is pustular psoriasis.

Infiltration of the epidermis by leukocytes is seen in all types of psoriasis but it is maximal in pustular psoriasis and usually seen when a patient has been improperly treated with oral steroids and these are wearing off.

This condition can generalise very quickly.

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