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?).


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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