What is pustular bacterid?

Pustular bacterid (of Andrews) is a controversial clinical eruption. Most dermatologists consider it to be a form of pustular psoriasis localized to the palms and soles. As originally defined by Andrews, pustular bacterid is a pustular eruption of the palms and soles in which the patient has no history or other clinical signs of psoriasis. The lesions are induced by low-grade bacterial infection in occult or evident foci, such as the teeth, tonsils, or gallbladder. The pustular eruption totally resolves with eradication of the infection. A later study has noted that injected Candida antigen aggravated up to 37% of patients with this disorder, suggesting that this phenomenon may not be restricted to bacterial infections. The recent recognition of bacterial “superantigens” provides a possible immunologic mechanism for induction of this disorder.

Stevens DM, Ackerman AB: On the concept of bacterids (pustular bacterid, Andrews), Am J Dermatopathol 6:281–286, 1984.