Generalized pustular psoriasis is life threatening and all individuals require hospitalization. Intravenous hydration, bed rest, avoiding heat loss and control of body temperature is very important. All metabolic and electrolyte deficiencies are corrected and the patients pain is controlled.
Antibiotics: If there is evidence of infection, IV antibiotics are started.
Compress: The burning and itchy skin lesions are treated with bland topical compresses. These compress sooth and also help to clean the skin. Cool compresses should initially be avoided to prevent heat loss.
Retinoids: If the patient is able to eat, oral medications like acitretin (vitamin A derivative) is administered. The medication has been shown to prevent flare ups of recurrent pustules.
Methotraxate: A common drug used in severe pustular psoriasis is methotraxate. This potent immunosuppressant drug is very effective in treating the acute episodes of the disorder.
Other medications: Colchicine, cyclosporine and hydroxyurea are other medications which are used. Because not everyone responds to methotraxate, these drugs are tried as a last resort.
Phototherapy: Patients usually are too sick initially and can react adversely to phototherapy. This light therapy is usually started after the patient is stable and the skin rash is under control. The light therapy is combined with oral psoralens and often helps relieve the symptoms.
Novel systemic therapies: There are several newer drugs which are used to treat pustular psoriasis. These medications (e.g., alefacept, etanercept, infliximab) have been used successfully in some cases of pustular psoriasis. the drugs are given intravenously over a period of few weeks. The occasional patient does respond adversely to treat these drugs. Other therapies, such as topical calcineurin inhibitors (e.g., tacrolimus, pimecrolimus) have also been shown effective in the treatment of the localized form of pustular psoriasis.
Consultation: A consultation from a dermatologist is highly recommended.