Arms and Legs Pustules

Pustules on the arms and legs

Scattered pustules on the arms and legs are usually follicular due to staph infection but Pityrosporon folliculitis and rarely Pseudomonas hot tub folliculitis may be found.Herpes zoster may present as a dermatomal band of pustules and blisters or herpes simplex as a recurrent localised area of grouped pustules.

Remember also that pustules may be inflammatory rather than infective.Sudden onset of multiple tender pustules suggests pustular psoriasis in a known psoriatic,a drug reaction or Kaposi's herpetiform or varicelliform eruption in a known atopic.Pustules on the forearms may be irritant from oils and tars.Pustules at the edge of a spreading scaly area suggest Tinea corporis.Scabies may cause pustules especially around the posterior elbow.

Management. Swab the pustules for bacteria,yeasts and viruses and order a smear to look for eosinophils.

SIGN DIP MEN  Overview of Pustules

 

S-Squamous    Tinea corporis(edge),Pustular Psoriasis,Subcorneal pustular dermatosis,localised pustular psoriasis,Reiter’s syndrome,Pleva,

 

I-Infective     Herpes simplex(grouped),Staph Folliculitis,Pseudomonas folliculitis,Acne vulgaris,Rosacea,Gonnococcemia,Chickenpox,Infected pompholyx eczema,Impetigo,Infected scabies,Ecthyma,Candidiasis(satellite pustules),Anthrax,Rarely secondary syphilis,Fungal septicemia due to candida,mucor or Cryptococcus,Hand foot and mouth disease,Kaposi’s varicelliform eruption

 

G-Granulomatous  Rosacea

 

N-Neoplastic

 

D-Drugs     Iodides and Bromides,Steroids,Norfloxacin,Frusemide,Cotrimoxazole,Fixed pustular drug eruption due to Amoxycillin,Antiepileptics and sulfonamides cause toxic pustuloderma.

 

I-Immunological  Variant of Dermatitis herpetiformis,Eosinophilic pustular folliculitis,Intestinal bypass dermatitis,Localised pustular vasculitis in rheumatoid arthritis,Impetigo herpetiformis,Sweet’s syndrome

 

P-Physical     Miliaria pustulosa,Swimmer’s itch,

 

M-Metabolic  Acrodermatitis enteropathica,

 

E-Endocrine

 

N-Nutritional  Acrodermatitis enteropathica

 

Others

Scalp Pustules  Bacterial infection,Dermatophytes,Dissecting cellulitis,Folliculitis decalvans,Traction alopecia at the edge,Erosive pustular dermatosis,

 

Generalised Pustulosis   Psoriasis,Impetigo herpetiformis,Herpes simplex,Candidiasis,Chickenpox,Scabies,Infected dermatitis,Drugs,Darier’s disease

 

Pustular Vasculitis   Behcet’s,Bowel associated dermatosis,Arthritic vasculitis,Primary cutaneous pustular vasculitis,Disseminated neiserial infections,Acute generalised pustular bacterid

Pustules on the abdomen suggests folliculitis but it may be pseudomonas rather than staphylococci.Most pustules are infective eg Tinea corporis,Pityrosporon folliculitis and Varicella but some are inflammatory.Spreading pustules originating in the groin and spreading out onto the abdomen suggest tinea cruris first but then disorders such as necrolytic migratory erythema,Sneddon Wilkinson disease or subcorneal pustular dermatosis or even acrodermatitis enteropathica.

Widespread Pustules in a Neonate -Pustular miliaria,Torch syndrome,Transient neonatal pustular melanosis,Incontinentia Pigmenti,Congenital varicella,Toxic erythema neonatorum,Letter-Siwe disease(Histiocytosis),Infantile acropustulosis,syphilis.

Pustules and Arthralgia -Gonnococcemia,Acne fulminans,Moxarella bacteremia,Chronic meningococcemia,Subcute bacterial endocarditis,Bowel associated arthritis syndrome,Behcet's syndrome,Hand foot and mouth disease.