Localized forms of pustular psoriasis primarily affect the palms, soles, or extremity digits. Descriptions of localized forms of pustular psoriasis include acrodermatitis continua of Hallopeau, a chronic pustular condition that primarily involves the digits, and palmoplantar pustulosis, a chronic condition in which the pustular eruption is primarily limited to the palms and soles. Affected individuals present between birth and 2.5 weeks of age with fetal distress, pustular rash, joint swelling, oral lesions and pain with movement. DITRA, a monogenic form of pustular psoriasis. Adults may also suffer from bony deformities and limb length discrepancies. Palmoplantar pustulosis (PPP) is a painful, debilitating inflammatory skin condition characterized by crops of sterile pustules localized to the palms and soles. If pustulosis is limited to the digits, herpetic whitlow, secondarily-infected malignancy and chronic bacterial, fungal or viral paronychia should also be considered. Psoriasis predominantly affecting the palms and soles takes two forms:. Acrodermatitis continua of Hallopeau (ACH): a rare indolent form of psoriasis with sterile pustular changes and dactylitis affecting the distal digits and nails. Referral is primarily for help with diagnosis and treatment, or if symptoms are particularly disabling. Directory Patient Local Patient Access.
Why do diseases affect both the skin and skeletal system? It affects primarily the small joints of the hands and feet. Treatment of psoriasis depends on the type, location, and extent of disease. Differential diagnosis includes psoriasis, atopic dermatitis, allergic or irritant contact dermatitis, and dermatophyte (tinea) infections. Skin disease typically follows trauma and occurs primarily on the hands, feet, elbows, and knees. Affected patients have papules on the eyelids and extremities that become purpuric and ecchymotic due to increased blood vessel fragility secondary to amyloid infiltration of the vessels.
Pustular psoriasis: In a population survey of psoriasis, pustular lesions were reported at any time during the course of psoriasis by about 20 of patients 11. Psoriasis clinically manifests as raised, well defined erythematous plaques with irregular borders and silvery scales, affecting the upper and lower extremities equally, but with a predilection for the elbows, knees, scalp, and trunk. When the palms and the soles are involved, this is known as palmoplantar psoriasis. Often, it begins after a localized trauma starting at the tip of a single digit 24. In 1876, Hutchinson described a much more severe form of the same condition, which he called cheiropompholyx. This chronic condition affects palms and soles, and may have periods of remission and exacerbation. Palmoplantar pustular psoriasis is strongly associated with cigarette smoking and is more common among females. Limb Salvage. Symptoms: Begins as red scaly papules that coalesce to form plaques. Chronic noncaseating granulomatous inflammation affecting primarily skin, eyes, lymph nodes and lung tissue of unknown etiology. Usually palms and soles are first to demonstrate rash.
Radiographics: Imaging Of Disorders Affecting The Bone And Skin
Dactylitis (inflammation of an entire digit), commonly termed sausage digit, also occurs in the spondyloarthropathies and is thought to arise from joint and tenosynovial inflammation. Diagnosis is based primarily on the history and physical examination. There are five recognized patterns of psoriatic arthritis: an oligoarticular type (four or fewer joints affected); Acute generalised pustular psoriasis is a rare but potentially life threatening complication of psoriasis, usually requiring inpatient hospital treatment. Patients with either form of cellulitis complain of pain, conjunctivitis, epiphora (insufficient tear film drainage from the eyes), and blurred vision. The causative pathogen is Neisseria meningitides, an aerobic Gram-negative diplococcus, and primarily affects young children and young adults with a male predominance. Red-pink macules and papules are seen on the palms and soles later in the course of disease. Erythema migrans is the most common clinical manifestation of localized disease and has been seen in as many as 89 of patients in one case series. Plaque psoriasis (see the image below) is rarely life threatening, but it often is intractable to treatment. Sausage digits. The disease more commonly affects the face in children than it does in adults. The 2 main forms of phototherapy are as follows:. Fissuring within plaques can occur when lesions are present over joint lines or on the palms and soles. 5 Introduction CHAPTER 1: introduction Epidemiology Psoriasis affects approximately 2. 6 Introduction with the limited form of the disease, may be treated with topical therapy, those with extensive (moderate to severe) psoriasis eventually require phototherapy, systemic or biologic therapy to adequately suppress the systemic, immunopathogenic process. Patients with pustules localized to the palms and soles have palmoplantar psoriasis; Primarily involves distal joints of the fingers and toes. Human skin, except for palms and soles, is quite thin and of variable thickness. The effect of an occupational exposure may range from the slightest erythema (reddening) or discoloration of the skin to a far more complex change, as a malignancy. Acroosteolysis, a type of bony disturbance of the digits, plus vascular changes of the hands and forearm (with or without Raynaud’s syndrome) has been reported among polyvinyl chloride polymerization tank cleaners. Allergic dermatitis, pompholyx, atopic eczema, pustular psoriasis and fungal infections are some examples.