Pustular Psoriasis: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Pustular Psoriasis?
A dermatologist, a doctor who treats skin conditions, usually leads care for pustular psoriasis. A primary care doctor can help spot the problem and send you to one. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is pustular psoriasis?
Pustular psoriasis is a type of psoriasis that causes pus-filled bumps called pustules. The bumps can form on the skin, and sometimes inside the mouth or under a nail.
Some people have pustules over large areas of the body, which is called generalized pustular psoriasis, or GPP. Other people have pustules in one area, such as the fingers and toes. GPP is the rarest form of psoriasis. It is also the most serious type of pustular psoriasis.
Other types are pustular psoriasis of pregnancy, palmoplantar pustulosis, and acrodermatitis continua of Hallopeau. Much of the detail below is about GPP, the most serious type.
Symptoms
The main sign is pus-filled bumps, usually white or yellow. In GPP, the bumps are painful.
In a GPP flare, bumps can join and break open. This leaves pus on the skin. As the skin dries, it turns red or purplish. Then the skin sheds. GPP can also cause fever, chills, dehydration, and a fast pulse.
GPP can also cause scaly or dry skin, swelling, itching, and burning.
Palmoplantar pustulosis causes pus-filled bumps on the hands, feet, or both. Acrodermatitis continua of Hallopeau causes painful bumps on the fingertips, toes, or both. Pustular psoriasis of pregnancy begins with bumps on the mother's inner thighs and groin.
Causes and who gets it
GPP is caused by abnormal inflammation. Inflammation is a normal immune system response, but when it is abnormal and uncontrolled, it can damage tissues and organs in the body. Flares can be set off by infection, by certain medicines, by menstruation, or by pregnancy. Stopping steroid pills called systemic corticosteroids is a common trigger.
Other reported triggers include emotional stress, injuries, sunlight, and smoking.
Changes in genes called IL36RN and CARD14 raise the risk of GPP. Having one of these gene changes does not mean a person will get GPP.
GPP can affect anyone at any age, but it is more likely in people aged 40 to 60. Females are slightly more likely to get it than males.
How doctors diagnose it
Doctors diagnose GPP from how the rash started, the signs and symptoms, and skin biopsy results. In a skin biopsy, a small piece of skin is checked under a microscope.
Lab tests alone do not confirm GPP. They can support the diagnosis and find problems it causes. Doctors may also test the pustules for bacteria, because the pustules of GPP are not infected.
Treatment
A dermatologist builds a plan around the type of pustular psoriasis. Where the bumps are and how many there are also matter. Age, symptoms, other health problems, and the medicines you take also matter.
For GPP, the FDA has approved spesolimab (Spevigo) as a treatment. Infliximab, a biologic medicine, can calm a flare quickly. Oral retinoids are pills made from vitamin A. If a medicine caused the GPP, doctors stop it when possible.
Palmoplantar pustulosis is often treated with corticosteroid creams, vitamin D creams, or light therapy.
A severe flare may need care in the hospital.
When to see a doctor
Get immediate medical care if you have pus-filled bumps over much of your skin along with fever or chills. Fever and chills can be signs that the psoriasis is becoming life-threatening.
Call 911 or go to the emergency room if you have trouble breathing, chest pain, fainting, or a sudden change in mental status, such as confusion.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can look at the skin, start the first steps, and refer you to a dermatologist.
Common questions
Is pustular psoriasis contagious?
No, the pustules of GPP are not contagious. They are sterile, which means they are not infected with bacteria or viruses.
Is pustular psoriasis life threatening?
It can be, especially generalized pustular psoriasis. A sudden flare needs immediate medical care.
Can pustular psoriasis come back?
Yes, GPP can come and go in flares. Some people have flares many times a year, and others only once every few years.
What triggers a flare of pustular psoriasis?
Triggers include infection, certain medicines, menstruation, and pregnancy. Often the trigger is unknown.
Sources
- American Academy of Dermatology - Pustular psoriasis: Treatment
- MedlinePlus Genetics - Generalized pustular psoriasis
- National Organization for Rare Disorders - Generalized Pustular Psoriasis
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
