The skin is the largest organ in our body. The integrity and beauty of the skin has been the object of study and advances in the pharmaceutical and cosmetic industry throughout history. However, the appearance of lesions that cause discomfort and alter the health of the skin is common, so in this article we will talk about pustules on the skin and how to treat them.

What are pustules?

The skin pustules are small lesions, punctate, containing pus and are located in the dermis or epidermis. These lesions can be an expression of an infection or inflammation in the skin and their presence can cause discomfort in the person who suffers them.

Why do pustules appear on the skin?

The pustules are formed due to inflammation covering the hair follicle and dermis. Sometimes this inflammation is secondary to an infection by bacteria or viruses, but it can also be due to immune reactions that promote the release of pro-inflammatory chemicals that produce pus inside the skin.

Causes of pustules on the skin

The pustules can be expression of skin diseases or systemic pathologies, being many causes that produce it . In order to simplify the diagnostic study of pustules on the skin , a team from the Dermatology Service of the Hospital Clínico Universitario San Carlos de Madrid, Spain, classified them into localized and generalized pustular lesions and infectious and inflammatory pustular lesions (Pedraz 2018) .

Localized infectious causes

  • Folliculitis and boils: they are infections of the hair follicle, generally associated with infections by skin germs. Folliculitis can be superficial and deep, and the deeper the condition, the longer it will take to heal. Folliculitis is usually evident on the scalp and forehead of babies, in addition to the beard of men. When the follicle becomes inflamed and forms a red nodule it is called a furuncle, which if it spreads can form a large collection of pus called an abscess.
  • Cutaneous candidiasis: it is the infection of the skin due to a fungus called Candida albicans , which generally affects the skin folds that become macerated and red. When cutaneous candidiasis occurs, pustules appear in isolation around the reddened areas of the skin.
  • Scabies: popularly known as scabies. In scabies, the pustules are located on the hands and soles of the feet, and accompany other types of pruritic generalized lesions such as excoriations (scratch marks) and furrows, produced by an ectoparasite called Sarcoptes scabiei.

Localized inflammatory causes

  • Pustule psoriasis : psoriasis is an autoimmune disease with scaly plaque-like lesions that, on rare occasions, may be accompanied by small pustules , especially after the application of local steroids.
  • Acne vulgaris: it is a very common cause of pustules . Generally, it is due to the inflammation of the skin associated with the production of pus and sebum, distributed on the face, chest, shoulders and back.
  • Rosacea: is the appearance of small pustules , which appear in the form of groups, near the mouth, forehead, nose and eyes. The latter is called ocular rosacea, which can cause visual discomfort. Most of the time, rosacea appears from changes in the weather, the use of cosmetics, spicy foods, and other irritants.

Generalized infectious causes

Among these causes is generalized folliculitis, which appears after the start of treatment with oral steroids (also known as steroid acne).

Another cause would be the over-infection of chickenpox lesions. Finally, there is eosinophilic folliculitis, which are pustules that appear secondary to Human Immunodeficiency Virus infection.

 Generalized inflammatory causes

These causes are less frequent, among these are generalized pustular lapsoriasis (or Von Zumbusch disease) that manifests itself by outbreaks of pustules on the trunk and upper limbs on a reddened patch of skin; in addition to subcorneal pustular dermatosis (or Sneddon-Wilkinson disease) that manifests as pustules grouped in ring-shaped folds of the skin, and finally, acute pustulosisexanthematic.

The latter has been described as a secondary effect of the use of some drugs such as beta-lactam and macrolide antibiotics.

How to treat pustules on the skin?

Treatment will depend on the cause and severity, and should also be indicated by a dermatologist. When it comes to pustules of infectious origin, depending on the extension and location, treatment with topical antibiotics such as bacitracin or mupirocin is indicated. Sometimes, it is enough to just keep the skin dry and hydrated and manual removal of the pustules is not recommended , since handling worsens the lesions and makes them converge.

When the condition is generalized and infectious in origin, oral or intravenous antibiotics are indicated. While if the lesion is inflammatory, topical or oral steroids are used, depending on the severity. In the case of candidiasis, an antifungal should be used. In addition to these treatments, the use of sunscreen and cleaning with products with a neutral pH are recommended ( Zuniga 2013) .

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses.He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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