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It is proposed to classify pustular diseases according to the initiating events and sites: purely epidermal pustules, follicular pustules or pustules noted in autoinflammatory syndromes. The unifying pathology in all of the three categories is a microinvasion of activated neutrophils into epidermal or adnexal epithelia. Formation of pustules involves established IL\u201017 \/ IL\u201023, IL\u201036 \/ IL\u201036RN driven pathology, or IL\u20101 \/caspase\u2010activated autoinflammation. Pathophysiology demonstrates an intriguing synergy of keratinocytes with neutrophils. This is called keratinocyte\u2013myeloid synergy (KMS). Non\u2010infectious pustules are formed by IFN\u03b1 controlling the production of chemoattractants (IL\u20108, LTB4) or induced by IL\u20101\u2010regulated inflammasomes and caspase\/ IFN\u03b2\u2010induced chemotaxins. The presence of physical barriers, for example, cornified cell layers (str. corneum), is instrumental in establishing chemotactic gradients and blocking migrating neutrophils. In follicular KMS\u2010driven pustular disorders, in contrast to epidermal pustules, neutrophil\u2010mediated toxicity propagates lasting and expanding ulcerating diseases with increased levels of circulating immunoglobulin A (IgA). Complexed IgA is suggested to propagate ongoing pustular diseases. These are prerequisites essential for developing pustules in burdensome human skin diseases.<\/jats:p>","DOI":"10.1111\/jdv.18279","type":"journal-article","created":{"date-parts":[[2022,7,18]],"date-time":"2022-07-18T08:12:12Z","timestamp":1658131932000},"page":"1157-1161","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pustular diseases and keratinocyte\u2013myeloid synergy"],"prefix":"10.1111","volume":"36","author":[{"given":"E.","family":"Christophers","sequence":"first","affiliation":[{"name":"Department of Dermatology University Hospital Schleswig\u2010Holstein  Kiel Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0682-6359","authenticated-orcid":false,"given":"J. 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