Acne necrotica miliaris is a pustular disease of the scalp that occurs predominantly in men. It is characterized by the presence of pruritic or painful, inflammatory papules surmounted by a small pustule. Because of the pruritus, many patients present with excoriated papules rather than with intact pustules. Usually, only one or two lesions are present at anyone time, but the overall course is chronic. The cause of the disease is unknown, but it frequently occurs in anxious, stressed individuals. Cultures reveal only the presence of Propionibacterium acnes. Orally administered tetracycline as used in the treatment of acne vulgaris is reasonably effective.

An acne-like folliculitis of the skin develops in some individuals following exposure to halogenated hydrocarbons and some other chemicals. This reaction is known as chloracne.

Perioral dermatitis generally presents as an eczematous disease but the process is occasionally characterized by the presence of pinpoint pustules clustered on the lower half of the face, predominantly around the mouth. Avoidance of topically applied steroids and the administration of tetracycline are quite helpful.

Gonococcemia may result in the development of arthritis, tenosynovitis, and the appearance of cutaneous cloudy or hemorrhagic vesicles. Some of these vesicles are opaque enough to be considered as pustules. Such lesions are generally few in number and are usually located on the hands and feet or are scattered in proximity to the large joints. Organisms cannot be cultured from the skin lesions but are recoverable from such sites as the cervix, rectum, or pharynx. Penicillin therapy is curative.

Clustered minute pustules on the fingers, toes, palms, and soles occur in several closely related diseases grouped under the heading acral jiustular dermatoses. The cause is unknown, but some of the patients have or will develop lesions of psoriasis elsewhere on the body. Patients with this condition have a higher-than-expected incidence of thyroid disease, and a surprisingly large number are cigarette smokers. Orally administered retinoids are quite helpful.

A few patients with widespread inflammatory psoriasis develop thousands of minute pustules superimposed on their cutaneous plaques. This condition, known as pustular psoriasis of Von Zumbusch, and a closely related variant, acute generalized exanthematous pustulosis, require hospitalization, intensive topical therapy, and systemically administered agents such as retinoids or methotrexate. Subcorneal pustular dermatosis shares many similarities with pustular psoriasis and may, in fact, be related to it. Impetigo herpetiformis is a pustular disease that occurs during pregnancy. It, too, is probably a form of pustular psoriasis.