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Pustular skin conditions
What are pustules?
Pustules are smaller than 5–10 mm, and filled with pus, that is, purulent material composed of inflammatory cells (neutrophils).
- Pus can indicate bacterial, fungal or viral infection
- Some pustules are sterile and are due to inflammatory skin disease
This topic provides a differential diagnosis of pustular skin conditions.
- Acute mainly pustular generalised eruptions
- Acute mainly pustular localised eruptions
- Chronic mainly pustular eruptions
Acute mainly pustular generalised eruptions
Generalised pustular psoriasis
- Febrile illness
- Annular plaques studded with pustules
Generalised pustular psoriasis
Acute generalised exanthematous pustulosis
- Febrile illness
- Drug eruption
- Diffuse superficial pustules
Acute generalised exanthematous pustulosis (AGEP)
Acute mainly pustular localised eruptions
Impetigo
- Rapidly enlarging plaque
- Swab Staphylococcus aureus +/- Streptococcus pyogenes
Impetigo
Furunculosis/boil
- Based on hair follicle
- May lead to abscess formation
- Swab Staphylococcus aureus
Furunculosis
Folliculitis
- Itchy or painful follicular pustules
- Various types
Bacterial folliculitis
Dermatophyte infection
- Kerion: abscess formation
- Due to zoophilic fungus, eg Microsporum canis
Kerion
Thrush
- Intertrigo, oral mucosa
- Superficial pustules that dry out easily
- Swab Candida albicans
Candidal intertrigo
Miliaria
- Sweat rash
Miliaria
Chronic mainly pustular eruptions
Acne
- Face, neck, upper trunk
- Comedones + inflammatory lesions
Acne vulgaris
Acneform eruptions
Acneform eruptions
Scabies
- Irregular pustules on hands and feet
- Burrows between fingers, volar wrists
- Papules axillae, groin
- Generalised itchy rash
Scabies
Dermatophyte infection
- Irregular annular plaque with peripheral scale
- Pustules on feet due to Trichophyton interdigitale
Dermatophyte infections
Palmoplantar pustulosis
- Hands, feet
- Sterile tender, itchy, pustules
Palmoplantar pustulosis
Erosive pustular dermatosis
- Sun damaged scalp
- May develop squamous cell carcinoma
- Lakes of greenish pus
- Culture may reveal Staphylococcus aureus
Many skin conditions present with pustules - see links to more On DermNet NZ in the Related Information Section below.
Bibliography
- Bachelez H. Pustular psoriasis and related pustular skin diseases. Br J Dermatol. 2018;178(3):614-18. doi:10.1111/bjd.16232 PubMed
- Filosa A, Filosa G. Neutrophilic dermatoses: a broad spectrum of disease. G Ital Dermatol Venereol. 2018;153(2):265-72. doi:10.23736/S0392-0488.18.05841-8 Journal
- Kutlubay Z, Tanakol A, Engýn B, et al. Newborn Skin: Common Skin Problems. Maedica (Bucur). 2017;12(1):42-7. PubMed Central
- Mengesha YM, Bennett ML. Pustular skin disorders: diagnosis and treatment. Am J Clin Dermatol. 2002;3(6):389-400. doi:10.2165/00128071-200203060-00003 PubMed
On DermNet NZ
- Acute febrile neutrophilic dermatosis
- Acute localised exanthematous pustulosis
- Blistering skin conditions
- Blisters and pustules in neonates
- Eosinophilic pustular folliculitis
- Gonorrhoea
- Gram-negative folliculitis
- Neutrophilic dermatoses
- Neutrophilic dermatosis of the hands
- Orf
- Neonatal cephalic pustulosis
- Pustular psoriasis of pregnancy
- Pyodermatitis-pyostomatitis vegetans
- Scalp folliculitis
- Subcorneal pustular dermatosis
- Toxic erythema of the newborn
- Transient neonatal pustular melanosis
Other websites
- Pustules — MedlinePlus
Books about skin diseases