1 Pustules Summary

Pustules are pus-filled sores that form on the skin. They may be small like a pimple with a white center surrounded by red skin, or they may grow larger in size. The sores may develop in any part of the body, but are more common in the face, neck, chest, back, thighs, pubic areas, and along the forearms.

They may also be found on shoulders, underarms, and hairline. Pustules may be form as a single entity or in clusters. They are very common among teenagers and young adults, mostly triggered by hormonal imbalances during puberty.

Some pustules may cause pain, while others do not. They form on the epidermis or in the lower layer, called the dermis. Pus is formed from inflammatory cells, dead foreign bodies like bacteria, and fighter T-cells in the blood.

These components accumulate under the skin of a pustule and remain there until it bursts. Once the pustule breaks, it releases the contents, leaving a small gap on the skin, which resolves over a period of time. Apart from these, pustules are also caused by various health issues, such as chicken pox.

Inflammation is one of the main causes of skin pustules. Infections, including bacterial, viral, and fungal infections may also lead to them. Diseases like psoriasis and acrodermatitis enteropathica also are implicated in the formation of pustules. Given the various health issues that can cause you to develop these sores, it is wise to seek a medical opinion; if you opt to treat these pustules with over-the-counter (OTC) medication, the underlying health condition could become much worse.

Inflammation may be caused by allergic reaction to food, other environmental allergens, or even by acne, which is a result of accumulation of oil, dead skin cells, and dead bacteria. The buildup of these components may lead to the formation of pustules. Sudden onset of pustules may indicate a bacterial infection. Painful and leaking pustules also need medical attention, so the moment you spot them on your skin leaking pus, consult your physician. These pustules are caused by various health conditions, some of them extremely serious and, if not treated on time, can lead to your health taking a turn for the worse. So instead of opting for OTC medications, the better choice is to consult a doctor and get an accurate diagnosis as to the underlying health issue that caused these pustules. Your doctor will then prescribe a course of treatment therapy to help you combat this effectively.

Symptoms that call for immediate medical care include:

  • Fever: If you are running a temperature along with having pustules on your body, you need to consult your physician at the earliest, as they could be an early warning sign of chicken pox.
  • Warm skin: If your skin is warm to touch and you have pustules on your body, contact your physician right away.
  • Nausea or vomiting: If you are experiencing nausea and vomiting along with pustules open on your skin, you need to meet up with your doctor and get yourself diagnosed right away. 
  • Diarrhea: If you experience diarrhea along with pustules all over your body, you need to consult a medical doctor right away since this can only indicate a more serious condition.
  • Pain in the region with pustules: If you are experiencing pain in and around the area where pustules have formed, you need to contact your doctor right away. On reviewing your condition, the doctor may prescribe antibiotics to offset the pain.
  • Large, painful pustules: This could be yet another indication of an underlying health condition, so talk to your doctor as soon as possible.

The morphologic pattern of a pustule in a region may indicate its cause. Some of the features that help identify this are the distribution of lesions, duration of pustules, and the general health and age of the patient.

Blood tests, particularly erythrocyte sedimentation rate (ESR) and complete blood count, are the most common tests used in the diagnosis of pustules. Serum chemistry studies that check the level of plasma globulins, albumins, zinc, and calcium are also regularly used. Pustule contents may be taken for culture to identify the cause of infection. This should enable your doctor to determine the underlying health issue causing these pustules and treat them. Since pustules are caused by several health conditions, you need to consult a doctor right away upon spotting them so they can run tests and provide you with a speedy diagnosis and effective treatment.

Small pustules may resolve without any specific treatment. Pustules caused by acne can be treated with home remedies: washing the face with warm water and a mild facial cleanser will help remove oil buildup, which leads to pus formation. But if these pustules do not resolve soon, it may be time to try out a few other home remedies.

Over-the-counter medications may be used to treat small acnes and pustules. Topical products containing peroxide, salicylic acid, and Sulphur also help reduce symptoms.

More aggressive treatment options are needed for pustules that do not respond to the conventional methods. Prescription medications like antibiotics are used to treat infections that cause pustules, and are offered in both oral and topical forms. Photodynamic therapy is another treatment option for controlling pustules. This is why it is a good idea to seek a medical consultation the moment you spot pustules instead of waiting for it to resolve, since more serious health issues could be the culprit (e.g. chicken pox).

2 Causes

There are multiple causes for the formation of pustules: 

  • Acne is one of the most common causes. It is formed by the buildup of oil, dead cells, dead bacteria, and dirt in the small pores of the skin. This accumulation results in the formation of small pimples, which may become reddish with pus at the tip (known as pustules). Scratching these is not a good idea since it can leave scarring on the face and other areas of the body where the pustules are located.
  • Scabies is a skin infestation caused by the mite Sarcoptes scabiei. The mites live and reproduce on the surface of the skin and burrow into it to lay eggs. This stage of mite infestation leads to the formation of pimples on the skin, which later become filled with pus, forming a pustule. Seek a medical consultation if you spot these pustules.
  • Rosacea is a skin condition characterized by flushing and redness on the face, broken blood vessels, and dry, scaly skin. This can cause breakouts of acne with reddish skin, and thus the formation of pustules. A combination of hereditary and environmental factors is implicated in the development of rosacea, so it is important you seek medical attention right away upon noticing these pustules, otherwise they can spread and even end up scarring your face.
  • Psoriasis is a chronic skin condition characterized by rapid growth of skin cells that accumulate on the surface. Different types of psoriasis may lead to pustules. Talk to your doctor the moment you spot any; they will probably do a blood test and a few others to determine the underlying health condition that caused this in the first place.
  • Chicken pox is a viral infection that leads to itchy, red blisters on the body. The small, red bumps on the skin may become filled with fluid or pus. These bumps develop into pustules, and new bumps continue to develop throughout the infection.  This disease is easily communicable to others, so take care, once your healthcare provider diagnoses you with chicken pox. To date, no permanent cure exists for chicken pox, and the infection is usually allowed to run its course. However, your doctor will prescribe a few antibiotics to alleviate your pain and discomfort, so consult them at the earliest.
  • Smallpox is a deadly viral infection characterized by flu-like symptoms and rashes. The rashes start on the face and gradually spread to other parts of the body,  developing into pustules. It can rapidly spread to other parts of the body and often leaves a pockmarked appearance. At present, smallpox has been eliminated in most countries around the world except a few.  
  • Hand, foot, and mouth disease is a common viral disease seen in children and infants, characterized by fever, sores, and rashes. Some of the rashes may accumulate fluid, developing into a pustule.  The moment you spot this, take your child to a pediatrician and get it treated right away.
  • Staphylococcus aureus infection causes nausea, vomiting, rashes, headache, and other symptoms. When the buildup of pus or fluid occurs in the rashes, pustules result.  With a timely visit to the doctor and speedy diagnosis, you can have it treated right away and lessen your pain and any other discomfort you may experience.
  • Candidiasis is a fungal infection caused by Candida albicans, characterized by a variety of symptoms including rashes, some of which develop into pustules. This infection can occur at different parts of the body but it mostly originates around the groin area. The moment you spot pustules in the groin area, consult your doctor.
  • Impetigo is a bacterial infection of the skin. First symptoms of impetigo are blisters, most commonly around the mouth and nose. The blisters may break open or accumulate pus, forming pustules.  This is why you should always wash your face thoroughly, but despite doing so, if you develop pustules around the mouth and nose, you need to consult a doctor. Your doctor will run a few tests to determine the underlying health issue and recommend an effective treatment therapy for you.
  • Acrodermatitis enteropathica is a malabsorption disease implicated in the development of pustules. In this disease, the body is unable to absorb sufficient quantities of zinc into the system, which results in the formation of vesicles and pustules on the skin. A blood test will confirm this, so head in to see your doctor at the earliest.
  • Folliculitis (inflammation and infection of hair follicles) is yet another cause of skin pustules. Bacterial invasion of the hair follicles causes bumpy, itchy rashes that later develop into pustules.  These pustules can often form in the forearms, head, and scalp. Consult your doctor for effective treatment therapy.

Other less common causes include conditions like erythema toxicum neonatorum, blastomycosis, infantile acropustulosis, gonococcemia, pompholyx, annular dermatitis, pustular miliaria, furunculosis, miliaria rubra, infantile acne, and staphylococcus scalded skin syndrome.

3 Diagnosis and Treatment

Medical history and a physical examination are the primary diagnostic procedures for identifying the cause of pustules. The doctor may ask questions about the onset of pustules or rashes, the regions where pustules started erupting, other associated symptoms, and triggers for the pustules, if any. When consulting your doctor, it is important for you to be upfront about your medical history and any medicines you may be allergic to, as it will have a bearing on your treatment.

Other tests and investigations may be conducted based on a suspected cause of the condition: complete blood count is used to check the levels of different blood cells; erythrocyte sedimentation rate reveals the presence of inflammation.

Serum chemistry may reveal an increase in plasma globulins, albumins, calcium, and zinc. The culture sample from a pustule may be used to identify the causative organism.

Small pustules may resolve on their own without any specific treatments. Persisting small pustules can be alleviated by washing with warm water and a mild cleanser; this helps remove the buildup of oil that leads to the formation of acne.

Many over-the-counter soaps and cream can remove small pustules. Topical products containing peroxide, salicylic acid, and Sulphur are also useful in treating them. Most of the topical products absorb the excess oil and dry the top layer of skin.

One must be careful, however, as some products may make the skin excessively dry, leading to peeling. Specialized products are available for sensitive skin in this case. Pustules should not be squeezed or pinched as it may worsen the infection and skin damage. Oil-based lotions and creams are not good for acne and pustules and should be avoided. These products aid in the further buildup of oil in the pores, worsening the pustules.

Most pustules resolve with home remedies and conventional treatment. More aggressive treatment may be needed for those which do not respond to the usual methods.

Persistent pustules are drained, and stronger medications are recommended for relieving symptoms. Prescription medications are suggested for pustules caused by bacterial infections.

Oral antibiotics like amoxicillin and doxycycline are also used to treat pustules caused by bacterial infections, and topical antibiotics like dapsone may be useful as well. The dosage of salicylic acid is increased to prescription-strength in these cases.

Photodynamic therapy is used to treat severe cases of pustules. This procedure involves the use of light and a special light-activated solution that helps destroy pustules.

The procedure is advantageous in that, in addition to the pustules, it also removes scars from old acne. It is also known to make skin smoother.

Other treatment methods depend on the underlying cause of the condition. For example, corticosteroids, vitamin D3-derivatives, coal tar, anthralin, and retinoids are suggested for pustules caused by psoriasis, while topical and oral antibiotics are recommended for controlling rosacea.

Lindane, permethrin, Sulphur, and hydrocortisone cream are recommended for pustules caused by scabies. For viral infections, symptomatic treatment, adequate rest, and fluids are suggested. The pustules will resolve when the infection reduces.

If left untreated, pustules may lead to severe complications, particularly if they are caused by infections. Abscess formation, encephalitis, endocarditis, meningitis, osteomyelitis, permanent scarring, pneumonia, sepsis, severe swelling, and tissue damage are just a few of the possible complications of pustules.

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