Pathogenesis of sterile pustulosis

The pathogenesis of sterile pustulosis involves various cells and inflammatory mediators. Upon outside stimulation, keratinocytes induce the accumulation of T lymphocytes and neutrophils respectively by CCL20/CCR6 system and peptide C 5a . T lymphocytes not only facilitate the formation of intraepidermal vesicles by the perforin/granzyme B and Fas/Fasl system, but also produce CXCL8 to enhance the recruitment of neutrophils and antigen presentation of keratinocytes. Meanwhile, activated neutrophils could express human leukocyte antigen (HLA) -DR and excite T lymphocytes to amplify the inflammation. Besides, the decrease of local or systemic levels of skin-derived antileukoproteinase also contributes to the formation of pustules.