Hidden Rash Behind the Behavior: New-Onset Pustular Psoriasis in Dementia

Pustular psoriasis is an uncommon variant of psoriasis characterized by crops of white-yellow brown pustules, erythema, scales, and fissures that can often be pruritic and painful, thus causing irritation and impacting quality of life.1 Localized forms include acrodermatitis continua of Hallopeau (ACH), which typically presents to the distal aspects of toes and fingers, and palmoplantar pustulosis (PPP) to the palms and soles. PPP has an estimated prevalence of 0.028% in a large United States database, with peak onset in adults 65-74 years old.2 This case highlights pustular psoriasis as an atypical contributor to worsening behaviors in a long-term care resident.