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Pustular skin conditions

Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, September 2015. DermNet Revision September 2021


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

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


  • Rapidly enlarging plaque
  • Swab Staphylococcus aureus +/- Streptococcus pyogenes



  • Based on hair follicle
  • May lead to abscess formation
  • Swab Staphylococcus aureus



  • Itchy or painful follicular pustules
  • Various types

Bacterial folliculitis

Dermatophyte infection

  • Kerion: abscess formation
  • Due to zoophilic fungus, eg Microsporum canis



Candidal intertrigo


  • Sweat rash


Chronic mainly pustular eruptions


  • Face, neck, upper trunk
  • Comedones + inflammatory lesions

Acne vulgaris

Acneform eruptions

Acneform eruptions


  • Irregular pustules on hands and feet
  • Burrows between fingers, volar wrists
  • Papules axillae, groin
  • Generalised itchy rash


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 in the Related Information Section below.



  • 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 

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