Pustular rash
A pustular rash is made up of crops of pustules—a visible collection of pus within or beneath the epidermis, commonly in a hair follicle or sweat pore. These lesions vary greatly in size and shape and can be generalized or localized to the hair follicles or sweat glands. (See Recognizing common skin lesions, page 459.) Pustules can result from a skin or systemic disorder, the use of certain drugs, or exposure to a skin irritant. For example, people who have been swimming in salt water commonly develop a papulopustular rash under the bathing suit or elsewhere on the body from irritation by sea organisms. Although many pustular lesions are sterile, a pustular rash usually indicates an infection. A vesicular eruption, or even acute contact dermatitis, can become pustular if secondary infection occurs.
History and physical examination
Have the patient describe the appearance, location, and onset of the first pustular lesion. Did another type of skin lesion precede the pustule? Find out how the lesions spread. Ask what medications the patient takes and if he has applied topical medication to his rash. If so, what type and when did he last apply it? Find out if he has a family history of a skin disorder.
Examine the entire skin surface, noting if it's dry, oily, moist, or greasy. Record the exact location and distribution of the skin lesions and their color, shape, and size.
Medical causes
Acne vulgaris.Pustules typify inflammatory lesions of acne vulgaris, which is accompanied by papules, nodules, cysts, open comedones (blackheads), and closed comedones (whiteheads). Lesions commonly appear on the face, shoulders, back, and chest. Other findings include pain on pressure, pruritus, and burning. Chronic recurrent lesions produce scars.
Blastomycosis.Blastomycosis is a fungal infection that produces small, painless, nonpruritic macules or papules that can enlarge to well-circumscribed, verrucous, crusted, or ulcerated lesions edged by pustules. Localized infection may cause only one lesion; systemic infection may cause many lesions on the hands, feet, face, and wrists. Blastomycosis also produces signs of pulmonary infection, such as pleuritic chest pain and a dry, hacking or productive cough with occasional hemoptysis.
Folliculitis.Folliculitis is a bacterial infection of hair follicles that produces individual pustules, each pierced by a hair and possibly accompanied by pruritus. “Hot tub” folliculitis produces pustules on areas covered by a bathing suit.
Furunculosis.A furuncle is an acute, deep-seated, red, hot, tender abscess that evolves from a staphylococcal folliculitis. Furuncles usually begin as small, tender red pustules at the base of hair follicles. They're likely to occur on the face, neck, forearm, groin, axillae, buttocks, and legs or areas that are prone to repeated friction. The pustules usually remain tense for 2 to 4 days and then become fluctuant. Rupture discharges pus and necrotic material. Then pain subsides, but erythema and edema may persist.
Impetigo contagiosa.Impetigo contagiosa, a vesiculopustular eruptive disorder that occurs in nonbullous and bullous forms, is usually caused by streptococci or staphylococci. Vesicles form and break, and a crust forms from the exudate: a thick, yellow crust in streptococcal impetigo and a thin, clear crust in staphylococcal impetigo. Both forms usually produce painless itching.
Pustular miliaria.Pustular miliaria causes pustular lesions that begin as tiny erythematous papulovesicles located at sweat pores. Diffuse erythema may radiate from the lesion. The rash and associated burning and pruritus worsen with sweating.
Pustular psoriasis.Small vesicles form and eventually become pustules with pustular psoriasis. The patient may report pruritus, burning, and pain. Localized pustular psoriasis usually affects the hands and feet. Generalized pustular psoriasis may erupt suddenly in a patient with psoriasis, psoriatic arthritis, or exfoliative psoriasis; although rare, this form of psoriasis can occasionally be fatal.
Rosacea.Rosacea commonly produces telangiectasia with acute episodes of pustules, papules, and edema. Characterized by persistent erythema, rosacea may begin as a flush covering the forehead, malar region, nose, and chin. Intermittent episodes gradually become more persistent, and the skin—instead of returning to its normal color—develops varying degrees of erythema.
Scabies.Threadlike channels or burrows under the skin characterize scabies, which can also produce pustules, vesicles, and excoriations. The lesions are a few millimeters long, with a swollen nodule or red papule that contains the itch mite.
Smallpox (variola major).Initial signs and symptoms of smallpox include high fever, malaise, prostration, severe headache, backache, and abdominal pain. A maculopapular rash develops on the mucosa of the mouth, pharynx, face, and forearms and then spreads to the trunk and legs. Within 2 days, the rash becomes vesicular and later pustular. The lesions develop at the same time, appear identical, and are more prominent on the face and extremities. The pustules are round, firm, and deeply embedded in the skin. After 8 or 9 days, the pustules form a crust and, later, the scab separates from the skin, leaving a pitted scar. In fatal cases, death results from encephalitis, extensive bleeding, or secondary infection.
Varicella zoster.When immunity to varicella declines, the virus reactivates along a dermatome, producing extremely painful and pruritic vesicles and pustules (herpes zoster, or shingles). Even with resolution of the rash, patients may experience chronic pain (postherpetic neuralgia) that may persist for months.
Other causes
Drugs.Bromides and iodides commonly cause a pustular rash. Other drug causes include corticotropin, corticosteroids, dactinomycin, trimethadione, lithium, phenytoin, phenobarbital, isoniazid, hormonal contraceptives, androgens, and anabolic steroids.
Nursing considerations
▪ Observe wound and skin isolation procedures until infection is ruled out by a Gram stain or culture and sensitivity test of the pustule's contents.
▪ If the organism is infectious, don't allow drainage to touch unaffected skin.
▪ Give medications to relieve pain and itching, and encourage the patient to express his feelings.
Patient teaching
▪ Explain the underlying disorder and treatment plan.
▪ Explain methods to prevent the spread of infection.
▪ Discuss ways to relieve pain and itching.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Blisters
Read excerpts from these other book chapters related to Blisters:
Medical Books Excerpts
- Pustular rash
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Skin, scaly
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Skin, scaly
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Blisters
» Next page: Skin, scaly (Nursing: Interpreting Signs and Symptoms)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
