Thinking I may have Pustular Psoriasis?

I am pretty certain I have pustulars. I’ve been told that pustular P may be caused by Humira. Any suggestions on either?

I have no experience with Humira…but lots with pustular psoriasis! My daughter had pustular psoriasis when she was between 4 and 12. Hers started as a yellow spot under her thumb nail and quickly spread to cover the whole thumb and palms of both hands. Hers appears as hundreds of bubbles of pus under the skin. The surface of the skin at that point was very smooth… You could see them but not feel them. Then they would “erupt” in unison and leave her hands bloody and raw. Almost looked like the top layer of skin was gone, leaving hundreds of deep “pits” where each pustule was. The skins would start to heal and the pustules would starts again. In the 8 years she had it, we rarely saw clear skin. Because of her age, the derm didn’t want her on stronger meeds unless it spread to 10% coverage. Luckily it just stayed on her palms which he said was about 2% coverage. Other than the steroid creams he had her on prescription antihistamines and said to give her children’s Tylenol. Surprisingly she rarely complained out it although sometimes had a problem holding her pencil in school.

Sorry I should add… She’s 18 now and it hasn’t come back. She has PsA and regular psoriasis on her knees and elbows.

Hi Christa,

Roni is right about the flares of pulstular. I had been on Enbrel and it didn't work the way my doctor wanted to and switched me to Humira. Now keep in mind many (and I mean many) factors happened in unison at this time but my pulstular presented after 2 injections of Humira, I had a bad case of strep throat, and my doctor was exchanging leflunomide for the methotrexate. This put me in the hospital for almost 2 weeks. My hands were as Roni stated, bloody messes and very, very raw.

Doctor took me off Humira and leflunomide; put me on Remicade and back on Methotrexate. My derm prescribed topical and UV therapy, which did as far as I could tell absolutely no good for me. This all occured in early 2008 and it took about 2 1/2 years for my skin to "clear up".

I still have issues with my hands as far as "use" and trauma problems; meaning, they do crack, skin breaks at the finger tips, hands become red and raw (especially in water), and mopping/sweeping/vacuuming is impossible to do without damage to my hands and fingers.

Get to your derm as soon as possible. My understanding about this type is the sooner the better for treatment. It is difficult to treat but is treatable. Some doctors may diagnose it as some form of skin infection, as that is what my docs did at first, it wasted time. The National Psoriasis Foundation has some good info about pulstular and I recommend you take a copy of it to your doctors. It could only help.

I hope your doctors figure this out soon and you're on a road to better days!

Thank you both for replying. My rheumy and his nurse practitioner both said its staph. So I am being treated with antibiotics and cream. It’s between my thighs and up along my pelvic area. But since Sunday they have been all between my legs and I have them continuously. I’m a little unsure of its only staph. But I’ll do the antibiotics for a few days and see. Today I was simply exhausted. Then caught a second wind. Not to mention the normal everyday pains.
I am truly sorry about your daughter and glad to hear she is better now. My mom Has had “problems” with her hands for years. Even went to the mayo clinic. I am 99% sure she has pustular psoriasis. And PsA. She and I don’t have the best relationship so when I told her what I thought she had she said I was over dramatic and I probably didt have it either. So with that said I leave her alone about it. But it’s what made me thing Pustulars to begin with.
Cooking a roast tonight. Feels good to be a bit productive today. So I’m going to say thank you both once again! I will keep you posted!!
Christa

anne marie said:

Hi Christa,

Roni is right about the flares of pulstular. I had been on Enbrel and it didn’t work the way my doctor wanted to and switched me to Humira. Now keep in mind many (and I mean many) factors happened in unison at this time but my pulstular presented after 2 injections of Humira, I had a bad case of strep throat, and my doctor was exchanging leflunomide for the methotrexate. This put me in the hospital for almost 2 weeks. My hands were as Roni stated, bloody messes and very, very raw.

Doctor took me off Humira and leflunomide; put me on Remicade and back on Methotrexate. My derm prescribed topical and UV therapy, which did as far as I could tell absolutely no good for me. This all occured in early 2008 and it took about 2 1/2 years for my skin to “clear up”.

I still have issues with my hands as far as “use” and trauma problems; meaning, they do crack, skin breaks at the finger tips, hands become red and raw (especially in water), and mopping/sweeping/vacuuming is impossible to do without damage to my hands and fingers.

Get to your derm as soon as possible. My understanding about this type is the sooner the better for treatment. It is difficult to treat but is treatable. Some doctors may diagnose it as some form of skin infection, as that is what my docs did at first, it wasted time. The National Psoriasis Foundation has some good info about pulstular and I recommend you take a copy of it to your doctors. It could only help.

I hope your doctors figure this out soon and you’re on a road to better days!

Anne Marie reminded me of the strep throat connection… The derm said that generally strep is the trigger and although she had never complained of a sore throat, he did a swab and she did have it. So initially he also had her on antibiotics. I also recalled that there was a cuticle cream…but I don’t recall the name. It was supposed to keep sections of the nail bed from dying which would prevent the nails from growing back. It seemed to work, since they fell off several times and always grew back. She has one thumb nail that is not attached properly on one side… But it has slowly gotten better over the years and is hardly noticeable now. I hope that’s not what you have… It was so difficult to treat and took years to get under control. Every time I thought I was getting close to remission, it would start all over again. She used to have to wear gloves to school and was so self conscious about it. I had a sustitute teacher say to her “if you’re too sick to hold a pencil then you shouldn’t be in school”. I was soooooo mad! All you had to do was take the glove off and see she hardly had any flesh left on her thumb pad! I was never so happy as when we hit that first 1 month clear mark… We had never managed that before. Before we knew it we had been a year clear and it all seemed like a bad dream!