Von Zumbusch Psoriasis: What Is It and What Triggers It?

Generalized Pustular Psoriasis or Von Zumbusch: Symptoms, Triggers, Treatment

Psoriasis on the leg.
Psoriasis on the leg. Tina Lorien/Getty Images

Von Zumbusch psoriasis is a rare type of psoriasis that is also known as generalized pustular psoriasis. Since psoriasis is a chronic disease of the immune system, so too is von Zumbusch psoriasis.

Pustular psoriasis affects all races and both men and women equally (though in children boys tend to be affected slightly more than girls). The average age of sufferers is 50 years and can be life-threatening, especially in the elderly.

Von Zumbusch can present at any age, through less commonly in young children and can appear out of the blue, even without previous psoriasis conditions, and can reoccur in periodic flare-ups.

Symptoms of Von Zumbush Psoriasis

Generalized pustular psoriasis is unlike other common forms of psoriasis in that instead of plaques, it covers the entire body with pus-filled blisters. Von Zumbusch psoriasis is a severe form of psoriasis and symptoms tend to be cyclical, with reddening of the skin followed by pustules and scaling:

  • The abrupt and widespread development of tender and painful reddened skin.
  • White pustules (blisters filled with non-infectious pus) appear a short few hours after the reddened skin.
  • The primary location of the pustules are in the flexural areas (the backs of the knees, the insides of the elbows, the armpits and the groin).
  • These pustules continue to spread and soon they join to form lakes of pus. The pustules rupture easily and can become infected.
  • Within 24 to 48 hours, the pustules dry up, giving a glazed and smooth appearance to the skin. Immediate medical attention is required as this condition can be fatal if the patient gets dehydrated, or the infection spreads to the bloodstream.
  • Subsequent symptoms associated with Von Zumbusch are:
    • Fever and chills
    • Severe itching
    • Dehydration
    • A rapid pulse rate
    • Exhaustion
    • Anemia
    • Weight loss and muscle weakness

    The pus inside the pustules consists of white blood cells. Those unfamiliar with psoriasis symptoms may mistakenly assume the affected area was caused by an infection or that it is contagious—psoriasis is neither an infection nor is it contagious.

    Triggers of the Condition

    It is not know what causes von Zumbusch psoriasis, but researchers know that it can be triggered by a number of different factors, such as:

    • Many oral medications
    • Irritating topical creams
    • Being overexposed to UV light
    • Pregnancy
    • Oral steroids
    • Various Infections
    • Stress
    • Stopping topical or oral steroids

    Oral steroids in psoriasis patients are actually dangerous. They do clear up the psoriasis while the patient is taking them, but after the patient stops, the psoriasis often comes back even worse. Any person with psoriasis who is prescribed oral corticosteroids for another condition should discuss their use with a dermatologist before taking them.

    Treatment Options

    People with von Zumbusch pustular psoriasis often need to be hospitalized for rehydration.

    Treatment includes a regimen of topical and oral medications, which typically includes antibiotics.

    Common medications include Acitretin, Cyclosporine or Methotrexate. For pustular psoriasis sufferers that are very sick or those that do not respond to other treatments, doctors may choose to prescribe oral steroids (which as described above, sudden withdrawal of steroids can trigger von Zumbusch).

    Other forms of therapy may include PUVA (an ultraviolet light therapy treatment) once the patient is past the severe stage of pustule development and redness has passed.


    National Psoriasis Foundation. Pustular Psoriasis. Accessed on Feb 23, 2016.

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