AMICROBIAL PUSTULOSIS OF THE FOLDS
By Gary White, MD
Amicrobial pustulosis of the folds (APF) is a rare pustular neutrophilic condition of the body folds. It resembles pustular psoriasis both clinically and histologically, but with an inverse distribution. (Would "pustular psoriasis of the body folds" be a better name?).
- In one review, 90% were woman with a mean age of 30 years [Ann Dermatol Venereol. 2017 Mar;144(3):169-175].
- It is associated with a variety of autoimmune diseases, in most cases systemic lupus erythematosus.
Scattered pustules and erosions develop acutely on erythematous skin. The skinfolds, anogenital region, scalp, external auditory meatus and umbilicus are preferred. Once the culture-negative status is confirmed, the differential diagnosis includes AGEP and pustular psoriasis.
Oral steroids are usually effective. Case reports exist of the use of anakinra and anti-TNF-alpha drugs.
Ann Dermatol Venereol. 2017 Mar;144(3):169-175
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