Localized Pustular Psoriasis: Symptoms, Causes, and Management
Skin ConditionsPsoriasis

Localized Pustular Psoriasis: What It Is and How It’s Managed

Localized Pustular Psoriasis: What It Is and How It’s Managed
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Published on November 18, 2025
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Localized pustular psoriasis is a term that refers to a limited area of small pus-filled blisters on your skin, typically on your hands or feet. It is distinct from generalized pustular psoriasis (GPP), which affects large areas of skin on the body and is a much more serious condition.

There are several potentially effective treatments available for localized pustular psoriasis, but there is no cure for the condition. Getting an accurate diagnosis can be a challenge, since there are other skin conditions with similar symptoms.

Types of Localized Pustular Psoriasis

Localized pustular psoriasis is generally understood to include two different types of psoriasis:

  • Palmoplantar Pustular Psoriasis (PPP or PPPP) Also known as palmoplantar pustulosis, this type of pustular psoriasis affects the palms of your hands, the soles of your feet, or both.
  • Acrodermatitis Continua of Hallopeau (ACH) This type affects only the tips of your fingers or toes, often including the nails.
Palmoplantar pustular psoriasis (PPP) is far more common than acrodermatitis continua of Hallopeau (ACH), which is very rare.

 In fact, some researchers believe that ACH should actually be considered a rare form of PPP.

Sometimes, a person with plaque psoriasis may develop pustules within the area of their plaques. “You can have limited plaque psoriasis that includes some areas that are pustular” without it being considered a separate type of localized pustular psoriasis, says Kimberly Katz, MD, a dermatologist at University of Washington Medicine in Seattle.

Signs and Symptoms of Localized Pustular Psoriasis

Localized pustular psoriasis is distinguished by pustules — white or yellow painful, pus-filled bumps — in the affected area of skin. These pustules may be surrounded by red, discolored, or inflamed skin.

A flare of palmoplantar pustular psoriasis often involves scattered white or yellow pustules on areas of discolored skin. As they dry out over time, these pustules can turn darker or brown.

The affected skin areas can also become scaly or cracked, potentially with deep cracks or breaks in the skin (fissures). Outbreaks can last for a very long time, potentially months or even years.

“Psoriasis on the hands and feet can affect quality of life in an enormous way,” says Dr. Katz. “There are lots of nerves on the hands, and we use them so much. And it’s very visible.”

Causes and Risk Factors of Localized Pustular Psoriasis

Like other forms of psoriasis, the causes of localized pustular psoriasis are not well understood. Psoriasis lesions — including pustules — happen when an overactive immune system speeds up the growth of skin cells.

Pustules, in particular, develop when immune system cells called neutrophils build up in the outermost layers of your skin.

Several factors may trigger the onset of localized pustular psoriasis, including:

  • Starting or stopping certain medications
  • Ultraviolet (UV) light exposure
  • Skin infections
  • Stress or changes to your routine
  • Pregnancy
Women are more than three times as likely as men to develop palmoplantar pustular psoriasis. It’s estimated that about 80 percent of people with palmoplantar pustular psoriasis are current or former smokers.

How Is Localized Pustular Psoriasis Diagnosed?

A diagnosis of localized pustular psoriasis will be based on several factors, including:

  • Physical exam
  • Your history of symptoms
  • Your complete medical history
  • Skin biopsy (tissue sample) and testing
  • Blood tests to help rule out generalized pustular psoriasis (GPP)
In a physical exam, your provider will be looking at the appearance and location of pustules and other features of your skin.

Testing a skin biopsy may help determine the cause of your pustules, and distinguish pustular psoriasis from other skin conditions that can cause similar symptoms, such as an allergic skin reaction.

“Often the patient’s history plays a large role” in the diagnostic process, says Katz. “Pustular psoriasis is more common if someone has a history of psoriasis.” And often, knowing a person’s medication history is key to ruling out a drug reaction as the cause of their symptoms. “Under the microscope, pustular drug reactions can look just like pustular psoriasis,” Katz says.

Treatment and Medication Options for Localized Pustular Psoriasis

There are a few main goals of treatment for localized pustular psoriasis:

  • Clearing pustules from skin
  • Relieving pain or itching
  • Preventing side effects and complications
Treatment options may include topical, oral, or injected or infused medications, along with other measures like phototherapy.

Medication Options

For less severe forms of localized pustular psoriasis, the following topical treatments may be used alone or in combination:

  • Corticosteroids (steroids)
  • Synthetic vitamin D
  • Salicylic acid
For more severe forms of localized pustular psoriasis, the following drugs may be prescribed:

  • Oral retinoids
  • Biologic medications
One research review found that the current evidence doesn’t support any particular treatment protocol for palmoplantar pustular psoriasis — and that the track record for biologic drugs in particular is mixed, with only very slow improvements and many people not tolerating the drugs well.

For acrodermatitis continua of Hallopeau, a research review found that oral retinoids and biologic drugs could both be effective treatments. A nonbiologic drug called apremilast (Otezla), which is prescribed for other forms of psoriasis, was also found to be somewhat effective.

Phototherapy

Also known as light therapy, phototherapy involves exposure to different wavelengths of light. One common form of this therapy is known as PUVA; a person takes a drug called psoralen and then has affected areas exposed to UVA, a type of ultraviolet light.

Prevention of Localized Pustular Psoriasis

There’s no known way to prevent localized pustular psoriasis. But if you have the condition, you may be able to reduce your risk of a flare-up by taking the following steps:

  • Clean the area frequently with a gentle cleanser.
  • Moisturize regularly.
  • Keep stress under control.
  • Avoid known or suspected triggers.

How Long Does Localized Pustular Psoriasis Last?

A flare-up of localized pustular psoriasis can take a long time to completely resolve — from a couple of weeks to a few months, depending on your response to different treatments.

There is no cure for localized pustular psoriasis, but you may be able to reduce or avoid future flare-ups by paying attention to potential triggers like irritants or allergens. Talk to your healthcare provider about identifying possible triggers if you aren’t sure.

Complications of Localized Pustular Psoriasis

People with localized pustular psoriasis may develop psoriatic arthritis, a form of arthritis that is also linked to other types of psoriasis. Some research suggests that about 30 percent of people with palmoplantar pustular psoriasis go on to develop musculoskeletal disease such as psoriatic arthritis.

Effective treatment for localized pustular psoriasis can reduce the risk of complications and related conditions, including psoriatic arthritis, heart disease, and depression.

The Takeaway

  • If you experience painful, pus-filled blisters on your hands or feet, consult a healthcare professional for an accurate diagnosis and appropriate treatment.
  • There is no cure for localized pustular psoriasis, but several treatments exist that may improve the symptoms and help you manage the condition effectively.
  • To reduce flare-ups of localized pustular psoriasis, try to identify and avoid potential triggers, manage your stress level, and regularly clean and moisturize the affected areas.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Pustular Psoriasis. National Psoriasis Foundation.
  2. Pustular Psoriasis. Cleveland Clinic. March 9, 2023.
  3. Menter A et al. Pustular Psoriasis: A Narrative Review of Recent Developments in Pathophysiology and Therapeutic Options. Dermatology and Therapy. October 9, 2021.
  4. Palmoplantar Pustular Psoriasis. National Psoriasis Foundation.
  5. Ludmann P. Pustular Psoriasis: Treatment. American Academy of Dermatology. August 29, 2024.
  6. Menter A et al. Pustular Psoriasis: A Narrative Review of Recent Developments in Pathophysiology and Therapeutic Options. Dermatology and Therapy. October 9, 2021.
  7. Iorizzo M et al. Acrodermatitis Continua of Hallopeau — Clinical Review and Proposed Management Algorithm. Journal of the American Academy of Dermatology. October 2025.
  8. Duffin KC et al. Pustular Psoriasis and Associated Musculoskeletal Disorders. Journal of Rheumatology. June 2021.
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Ross Radusky, MD

Medical Reviewer
Castle Connolly Top Doctor

Ross Radusky, MD, is a practicing board-certified dermatologist at the Dermatology Treatment and Research Center in Dallas. Originally from New York City, he graduated summa cum laude from the City University of New York and then received his MD from the New York University School of Medicine. There, he was inducted into the Alpha Omega Alpha Honor Medical Society and served as chapter president for two years. He completed his residency in dermatology at NewYork-Presbyterian Hospital and Weill Cornell Medical Center, and at Memorial Sloan Kettering Cancer Center.

Dr. Radusky practices general and cosmetic dermatology with a focus on the early detection of skin cancer, and provides patients with a personalized approach to looking their best at any age. He has authored articles and textbook chapters on the clues that our finger- and toenails may provide us about internal disease, as well as on comprehensive therapies for cosmetic dermatology and reversing the signs of skin aging.

Complementing his medical practice, Radusky has a strong passion for the cultural arts, particularly in expanding access to youths and seniors. He previously served as an artist instructor for the Rockaway Artists Alliance, a New York City nonprofit arts and education organization, and then served as both a board director and treasurer of the organization throughout his medical school training.

Radusky enjoys spending time outdoors with his wife Robyn, son Oliver, and poodle Lucy, where he can usually be found preventing photoaging and reducing the risk of skin cancer beneath an umbrella in a wide-brimmed hat. He is also the proud inventor of Sunshotz, the world’s only sunscreen measuring cup, designed to help patients of all ages apply the proper amount of sunscreen needed to enjoy all the sun without the burn.

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Quinn Phillips

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A freelance health writer and editor based in Wisconsin, Quinn Phillips has a degree in government from Harvard University. He writes on a variety of topics, but is especially interested in the intersection of health and public policy. Phillips has written for various publications and websites, such as Diabetes Self-Management, Practical Diabetology, and Gluten-Free Living, among others.

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