Miscellaneous Pustular Diseases-Skin Disorders Cure

Acne necrotica miliaris is a pustular disease of the scalp that occurspredominantly in men. It is characterized by the presence of pruriticor painful, inflammatory papules surmounted by a small pustule. Becauseof the pruritus, many patients present with excoriated papules ratherthan with intact pustules. Usually, only one or two lesions are presentat anyone time, but the overall course is chronic. The cause of thedisease is unknown, but it frequently occurs in anxious, stressedindividuals. Cultures reveal only the presence of Propionibacteriumacnes. Orally administered tetracycline as used in the treatment ofacne vulgaris is reasonably effective.

An acne-likefolliculitis of the skin develops in some individuals followingexposure to halogenated hydrocarbons and some other chemicals. Thisreaction is known as chloracne.

Perioral dermatitis generallypresents as an eczematous disease but the process is occasionallycharacterized by the presence of pinpoint pustules clustered on thelower half of the face, predominantly around the mouth. Avoidance oftopically applied steroids and the administration of tetracycline arequite helpful.

Gonococcemia may result in the development ofarthritis, tenosynovitis, and the appearance of cutaneous cloudy orhemorrhagic vesicles. Some of these vesicles are opaque enough to beconsidered as pustules. Such lesions are generally few in number andare usually located on the hands and feet or are scattered in proximityto the large joints. Organisms cannot be cultured from the skin lesionsbut are recoverable from such sites as the cervix, rectum, or pharynx.Penicillin therapy is curative.

Clustered minute pustules onthe fingers, toes, palms, and soles occur in several closely relateddiseases grouped under the heading acral jiustular dermatoses. Thecause is unknown, but some of the patients have or will develop lesionsof psoriasis elsewhere on the body. Patients with this condition have ahigher-than-expected incidence of thyroid disease, and a surprisinglylarge number are cigarette smokers. Orally administered retinoids arequite helpful.

A few patients with widespread inflammatorypsoriasis develop thousands of minute pustules superimposed on theircutaneous plaques. This condition, known as pustular psoriasis of VonZumbusch, and a closely related variant, acute generalizedexanthematous pustulosis, require hospitalization, intensive topicaltherapy, and systemically administered agents such as retinoids ormethotrexate. Subcorneal pustular dermatosis shares many similaritieswith pustular psoriasis and may, in fact, be related to it. Impetigoherpetiformis is a pustular disease that occurs during pregnancy. It,too, is probably a form of pustular psoriasis.