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Non-infectious vesiculopustular dermatoses: causes, symptoms, diagnosis, treatment
Medical expert of the article
Last reviewed: 07.07.2025
Non-infectious vesiculopustular dermatoses characterized by the presence of sterile pustules in the skin include a large group of diseases, including both generalized and limited forms. Generalized pustuloses include herpetiform impetigo, subcorneal pustulosis of Sneddon-Wilkinson, and localized pustuloses include acrodermatitis of Hallopeau, palmoplantar pustulosis, and Andrews pustular bacterid. The common primary morphological element of all these diseases - a pustule with sterile contents - histologically corresponds to the exocytosis of neutrophilic granulocytes with the formation of intraepidermal pustules. The histogenesis of pustules is based on the chemotaxis of neutrophilic granulocytes, associated with the presence of chemoattractants in the epidermis, which can be metabolites of arachidonic acid (12HETE, leukotrienes), epidermal thymocyte-activating factor (ETAF), activated fractions of complement C3a, C5a and C567. To a large extent, the intensity of chemotaxis depends on the properties of the neutrophilic granulocytes themselves.
The etiology of most non-infectious pustular skin diseases remains unclear, but infection and drug exposure as provoking factors are considered important in their pathogenesis. The involvement of hypersensitivity mechanisms is assumed, which is confirmed by the presence of immune disorders.
There is also no clarity in their classification, which is largely due to the lack of clear differential diagnostic criteria, especially in limited forms of pustulosis. The relationship of pustulosis with common and generalized psoriasis is unclear. The morphological similarity of pustulosis has given rise to the opinion that they are different forms of the same disease. It has been proposed to combine them under the general name "pustular psoriasis". A number of authors consider all diseases included in this group to be pustular variants of common psoriasis. At the same time, it must be acknowledged that pustular skin diseases differ significantly from each other in their clinical picture, course, and prognosis. Most domestic and some foreign authors consider the pustular diseases included in this group to be independent nosological entities.
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