Infections

[Scabster]

Hi, I have palmoplantar pustular psoriasis diagnosed by a dermatologist around 7 years ago. I had my first flare for approximately a year, then was clear (a few pustules here and there) until the start of this year. I was diagnosed with cellulitis 2 months ago from infected psoriasis. I took abx for a week (clindamycin) and after a few days the infection cleared and also I did not have any pustules for around a week. I now have what I suspect is another infection. No drs appt till a few weeks although I Will call for cancellations. I have been getting what appears to be folliculitis on most parts of my body, one or two at a time for months, however recently there have been more mostly on my legs and ankles. I do not think they are gpp sometimes they look like insect bites with a blister or just a red lump, but then they get yellow heads often. They are itchy. Nobody else in the house has rash/spot/bites and I don't believe they are bites as I have had plenty and they don't behave like this. I have had a boil and a few smaller ones in my groin in the last few months also.
So I have two questions
1. Why would clindamycin stop pustule formation temporarily?
2. Is it unreasonable to ask the gp to swab test me to see what is causing the infections and rash, rather than just prescribing abx. For example if it's staphs is it possible to formulate a skin care and hygiene routine to try to prevent any more infection?
Thank you for your time.

[Julie Van Onselen]

Hi Scabster

Thank you for your post. I am sorry to hear you have had a difficult time with skin infection, alongside your pustular palmoplantar psoriasis. Firstly, just a general point for everyone - Palmoplantar pustular psoriasis (PPP) affects the soles of the feet and palms of the hands, it appears as small white or yellow blisters (pustules) appear on top of very red or darkened skin. These pustules are filled with fluid which often gives them a yellow or cream colour, and they may dry up and turn brown or crusty after they have burst. The red or darkened skin around the pustules is often thick and flaky, and is often prone to cracking. The pus in the pustules is not a symptom of infection or bacteria, and, as with all types of psoriasis, they are not contagious.This information is from https://www.psoriasis-association.org.u ... -psoriasis

Therefore PPP does not cause infection or folliculitis on the body. Cellulitis is a streptococcus infection, that can happen to anyone whether they have psoriasis or not, it can also recur. We are unable to diagnose at this online clinic or give specific treatment advice, but it sounds as if you describe generalised skin infection and I agree you need a firm diagnosis (skin swabs would confirm the bacteria) and a management plan (you are likely to require more antibiotics as you have pus formation, but the bacteria needs to eb sensitive to the antibiotic). I would suggest you ask for an emergency appointment, as you have an acute infection and need prompt treatment. I would also suggest you discuss a dermatology referral with your GP, as infected psoriasis is uncommon and it sounds like you need dermatology assessment. I hope this helps and your infection resolves soon.