Flexures Pustules

Pustules in the flexures

 

Pustules in the flexures are the same as pustules elsewhere.Infection first particularly Staph folliculitis and candida with its characteristic satellite pustulosis.Tinea with pustules in the advancing scaly edge is also commonly seen.However whenever you see pustules at an advancing edge you have to consider necrolytic migratory erythema,subcorneal pustular dermatosis,acrodermatitis enteropathica,Hailey Hailey disease,Pemphigus vegetans  and pustular psoriasis.Many flexural rashes become secondarily infected.This is more common than a primary pustular disorder.

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.