MULTIPLE PUSTULES

By Gary M. White, MD


This differential deals with diseases which produce pustules unassociated with the follicle. For pustules originating within the follicle, see folliculitis.

Note: As a general rule, any pus should be cultured.

Adult

Impetigo
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Herpes Simplex. Vesicles turning into pustules here.
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Herpes Zoster

Tinea can sometimes present with pustules. See Majocchi Granuloma
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Pustular Psoriasis
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Acute Generalized Exanthematous Pustulosis picture here

Subcorneal Pustular Dermatosis. Photographs courtesy Gary Cole, MD
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Impetigo Herpetiformis
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IgA Pemphigus/Intraepidermal Neutrophilic IgA Dermatosis

Gonococcal Infection, Disseminated

Iododerma

Bowel-Associated Dermatitis Arthritis Syndrome

Pemphigus Foliaceus

Pemphigus Vulgaris presenting with pustules. A 34-year-old man with pustules on the site of right costal part for one week. Indian J Dermatol 2010;55:293-5

Klebsiella Sepsis. A 62-year-old woman presents with fever and abdominal pain. A liver abscess was found. She was also noted to have numerous pustules scattered along her face, trunk, and limbs. Most of these had a reddish to purpuric rim. Blood, liver abscess, and skin pus all grew Klebsiella pneumoniae. [CED 2013;38;626]

Pustular Drug Eruption. A 50-year-old woman started on hydroxychloroquine (HCQ) for arthritis developed a diffuse erythematous eruption with pustules. It took 81 days, stopping the HCQ, and prednisone to finally clear the eruption [Cutis 2016;97;212].

Infant with Pustules

Pustules in an infant should always prompt a culture to rule out Staphylococcal or Candidal infection. Later stages of herpes can look pustular as well.

Bullous Impetigo

Erythema Toxicum Neonatorum. Papulopustules on the face of a newborn.

Transient Neonatal Pustulosis. Similar to erythema toxicum, but leaves transient pigmented macules.

Congenital Candidiasis

Neonatal Candidiasis

Miliaria Rubra

Eosinophilic Pustular Folliculitis of Infancy Lesioins most commonly occur on the scalp.

Infantile Acropustulosis Lesions most common on the palms and soles.
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Pustules in a Photodistribution

Actinic Folliculitis

Rare Variants with Pustules

Granuloma Annulare [Dermatology 1999;199;85]

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