Pustular psoriasis flare-ups can be triggered by some medicines, irritating substances on the skin, ultraviolet light overdoses, pregnancy, systemic steroids (especially sudden withdrawal of tablet or high potency topical steroids), infections or emotional stress. It can occur abruptly, sometimes precipitated by the triggers mentioned above and it can make the person feel quite unwell with fever, shivers, intense itching, rapid pulse rate, exhaustion, headache, nausea, muscle weakness and/or joint pain. Methotrexate is the most common treatment for pustular psoriasis. Several new agents to treat psoriasis are under study, including oral medications and injectable agents. The most common type is called plaque psoriasis, also known as psoriasis vulgaris. A number of conditions may trigger pustular psoriasis, including infection, pregnancy, certain drugs, and metal allergies. Part of the process involves an abnormal immune response, which causes inflammation and rapid production of immature skin cells. Information about the types of pustular psoriasis including von Zumbusch psoriasis, palmoplantar pustulosis and acropustulosis or acrodermatitis continua of Hallopeau. Generalized pustular psoriasis also can cover most of the body. Sudden withdrawal of systemic medications or potent topical steroids. Palmoplantar pustulosis (PPP) causes pustules on the palms of the hand and soles of the feet.
Withdrawal of systemic steroids is the most common precipitating factor in developing pustular or erythrodermic psoriasis, rare life-threatening forms of the disease. Keep in mind that rapid withdrawal of a steroid can leave the body unable to produce enough of its own steroids to support blood pressure and other necessary functions, in rare cases resulting in death. Although topical steroids rarely cause the serious side effects that oral steroids can, cautions still apply. It generally appears on people who have unstable plaque psoriasis. It may also occur in association with von Zumbusch pustular psoriasis. Oral medications may be offered to those with severe or treatment-resistant eczema. Most people with eczema use topical treatments (lotions, creams and ointments). One of the most common reasons topical steroids are ineffective is that they are not used enough. On discontinuing the oral antibiotic, the patient may suffer another flare.
Children are more vulnerable to their side effects, particularly the effects on growth, immunity and adrenal suppression. In pediatric dermatology, long-term systemic steroids may be used for the treatment of erythroderma due to atopic eczema, pustular psoriasis, childhood pemphigus, chronic bullous dermatosis of childhood, systemic lupus erythematosus, pyoderma gangrenosum or complicated hemangiomas. Alternative forms of glucocorticoids such as deflazacort, an oxazolone derivative of prednisolone, appear to have fewer effects on growth and corticosteroid-induced osteoporosis, but are not used in common practice. Includes common and rare side effects information for consumers and healthcare professionals. More common Abdominal or stomach pain or tenderness. Cyclosporine causes a reversible reduction in renal blood flow and glomerular filtration rate. Seizures in patients on cyclosporine therapy may be associated with hypomagnesemia or concomitant high-dose corticosteroids. Postmarketing cases of transformation to erythrodermic psoriasis or generalized pustular psoriasis upon either withdrawal or reduction of cyclosporine in patients with chronic plaque psoriasis have been reported. Use of parenterally administered drugs (more likely to cause anaphylaxis). Any improvement after drug withdrawal and any reaction with readministration. Therapy for exanthematous drug eruptions is supportive, involving the administration of oral antihistamines, topical steroids, and moisturizing lotions. Adverse Reactions to Antihistamines More Common Than Thought.
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A total of 61 of patients experienced side effects, with 20 discontinuing therapy. Prompt recognition of severe reactions, drug withdrawal, and appropriate therapeutic interventions can minimize toxicity.