Psoriasis vulgaris cum pustulatione L40.0

Intermittent occurrence of a mostly temporary, eruptive pustule in the area of already (longer) existing foci in psoriasis vulgaris. Pustule episodes can be accompanied by disturbances of the general condition up to fever.

• Few to numerous, localized or disseminated, usually symmetrically distributed, scaly, variably elevated (infiltrated), red, sharply demarcated plaques of variable size (0.5cm to 10.0cm and >) and configuration (roundish or oval, map-like). Around the plaques varying numbers of white or gray-white pustules, varying in size, vulnerable and easily bursting, usually forming within a few days. In confluence, formation of weeping areas.
• Auspitz phenomenon is triggerable in the (pre-existing) psoriatic plaques.
• There is usually a high endogenous eruption pressure.
• Relapsing course with different relapse frequencies is characteristic.
• see also overview chapter Psoriasis

Increased inflammation parameters (CRP, BSG); neutrophil leukocytosis;

• Initially, use dithranol only in low concentrations and increase the concentration very slowly (s.a. psoriasis vulgaris). Accompanying daily brine baths and tar baths are also possible (e.g. Balneum Hermal with tar). If necessary, use in combination with UVB. Increase UV doses very carefully. Avoid Dermatitis solaris under all circumstances.
• Alternative: Short-term external application of glucocorticoids, especially in case of fresh attacks. Pustules disappear after hours or days. After stopping the pustular flush, change to the classic external therapy scheme. Caution! Avoid irritating external agents!

Notice! The push activity is usually limited in time. Therefore the focus of the therapy has to be put on external measures!