Pustular Skin Lesions - Differential Diagnosis Framework
What are pustules?
• Pustules < 5-10 mm + pus
• Material composed of inflammatory cells (neutrophils)
• Pus --> bacterial, fungal, or viral infection
• Some pustules are sterile and are due to inflammatory skin disease
Pustular Localised Eruptions (Face/Scalp):
1. Impetigo
2. Furunculosis/boil
3. Folliculitis
4. Dermatophyte infection
5. Kerion
Inflammatory, pus-filled sore (abscess) that sometimes oozes:
1. Thrush/Candidal intertrigo
2. Herpes zoster
3. Herpes simplex
4. Pityrosporum/Malassezia folliculitis
5. Rosacea
Pustular Diffuse Eruptions (Trunk):
1. Acne vulgaris
2. Acneiform eruptions
3. Miliaria
4. Scabies
• Irregular pustules on hands and feet
• Burrows between fingers, volar wrists
• Papules axillae, groin
• Generalized itchy rash
5. Dermatophyte infection
6. Palmoplantar pustulosis
7. Erosive pustular dermatosis
8. Hidradenitis suppurativa
9. Bacterial folliculitis/hot tub folliculitis
10. Fire ant bites
11. Pustular psoriasis (GPP)
12. Subcorneal pustular dermatosis (Sneddon-Wilkinson disease)
13. Mpox
• Starts on face --> spreads to trunk
• Pustules >> look like bumps >> blisters that eventually scab over.
14. SAPHO syndrome (synovitis, acne, pustulosis, osteitis) - Pustular skin disease in association with rheumatic pain.
15. Pustular Eczema
Pustules + Fever:
1. Eosinophilic folliculitis
2. Varicella
3. Acute generalized exanthematous pustulosis
• Febrile illness
• Drug eruption
• Diffuse superficial pustules
4. Disseminated gonococcemia
5. Secondary syphilis
6. Pustular psoriasis (GPP)
7. Pyoderma gangrenosum
8. Sweet syndrome
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