What are the other Names for this Condition? (Also known as/Synonyms)

• Localized Pustular Psoriasis (LPP)
• Palmoplantar Pustular Psoriasis
• Pustulosis Palmaris Et Plantaris

What is Palmoplantar Pustulosis? (Definition/Background Information)

• Palmoplantar Pustulosis (PPP) is a rare skin condition of unknown cause that is characterized by the formation of pus-filled blisters on the palms and soles. It is associated with individuals who have a history of smoking, psoriasis, or certain autoimmune disorders
• The condition may last for several years, cause severe discomfort, and affect one’s normal life. Palmoplantar Pustulosis is also difficult to treat; the treatment may involve topical creams and ointments, oral medications, and adequate self-care

Who gets Palmoplantar Pustulosis? (Age and Sex Distribution)

• Palmoplantar Pustulosis are generally observed in adults (in the 40-70 years age group); children are not commonly affected
• Both males and females are affected, but more women than men are affected
• Worldwide, there is no racial or ethnic preference observed

What are the Risk Factors for Palmoplantar Pustulosis? (Predisposing Factors)

The risk factors for Palmoplantar Pustulosis may include:

• History of smoking - both past and currently smoking individuals have a high risk. According to medical literature, between 65-90% of the individuals with Palmoplantar Pustulosis present a smoking history
• Personal history or family medical history of psoriasis; 10-25% of the individuals with Palmoplantar Pustulosis have chronic plaque psoriasis
• Contact allergies
• Individuals with the following autoimmune conditions are at a high risk:
  • Arthritis
  • Celiac disease
  • Thyroid disease
  • Type 1 diabetes
• Infections such as:
  • Chronic tonsillitis
  • Chronic sinusitis
  • Dental infection
  • Strep throat
• SAPHO syndrome (in rare cases)
• Use of certain medications such as TNF-alpha inhibitors

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Palmoplantar Pustulosis? (Etiology)

Presently, the exact cause of development of Palmoplantar Pustulosis is not well-understood. Medical experts have proposed several explanations towards its development, which include:

• Palmoplantar Pustulosis may be an autoimmune inflammatory condition
• Abnormalities associated with the functioning of the sweat glands on the palms and soles
• In some cases, a family history of the condition is noted, it is believed that genetic factors may be involved; the involvement of IL36RN gene is noted in a few cases
• The condition may be drug-induced; the involvement of tumor necrosis factor (TNF) alpha inhibitors has been observed
• Since a majority of individuals with Palmoplantar Pustulosis exhibit smoking history, it is believed that the nicotine in smoke may be involved in the development of this condition

What are the Signs and Symptoms of Palmoplantar Pustulosis?

The signs and symptoms of Palmoplantar Pustulosis may include:

• Presence of numerous collections of pus-filled blisters on the palms of hands and soles of the feet
• These are termed sterile pustules, since they are inflammatory blisters and bacterial cultures of the pus are negative
• The affected region is red with scaly skin that form cracks
• Pain and severe discomfort is commonly observed
• The pustules typically come in crops, dry up at about the same time, and later recur
• Both hands and feet may be affected

When the tips of the finger and toes, as well as nails are involved, the condition is known as acrodermatitis continua of Hallopeau, which is a subtype of Palmoplantar Pustulosis.

How is Palmoplantar Pustulosis Diagnosed?

A diagnosis of Palmoplantar Pustulosis may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation; a visual exam of the hands and feet may help the healthcare expert arrive at a diagnosis
• Blood tests as needed, bacterial culture of pus, and KOH exam of pus for yeast
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Palmoplantar Pustulosis?

The possible complications due to Palmoplantar Pustulosis include:

• Emotional stress due to cosmetic issues
• Difficulty in performing simple tasks such as walking, using a mobile phone, etc.
• Interference with one’s work, especially manual jobs
• Social self-isolation
• Relapse and remission; the condition can often persist for several years
• Superimposed bacterial and fungal skin infections
• Treatment difficulties and complications

How is Palmoplantar Pustulosis Treated?

Management of Palmoplantar Pustulosis is often difficult and challenging since it is resistant to treatment. It involves the use of topical agents, oral medications, self-care measures, and lifestyle changes. An individualized treatment regimen may be arrived at for each patient based on the healthcare provider’s assessment.

The treatment measures available for Palmoplantar Pustulosis include:

• Undertaking treatment of the underlying condition if any
• Application of topical steroidal creams and ointments, use of coal tar ointments
• Bandage dressing
• Treatment with oral dapsone
• Administration of oral retinoids
• Phototherapy, PUVA or UVB
• Treatment using immunosuppressants
• Antibiotic therapy for secondary infections
• Medications such as methotrexate
• Biological therapies

Self-care (home) measures:

• Stop smoking
• Use moisturizing creams
• Use proper footwear made from natural materials
• Keep nails trimmed
• Do not scratch or pick at the lesions
• Wash the lesions with mild soap (antibacterial)
• Apply warm compress
• Wash hands before applying topical applications
• Avoid activities that create friction in the palms or soles
• Minimizing stress may help improve the symptoms

Regular follow up visits with the healthcare provider is important and recommended.

How can Palmoplantar Pustulosis be Prevented?

It may not be possible to prevent Palmoplantar Pustulosis in all cases, although the risk factors for the condition may be mitigated through the following measures:

• Cessation of smoking
• Consider suitable treatment for psoriasis, autoimmune disease, or other contributory conditions
• Discontinuing the offending medication causing Palmoplantar Pustulosis

What is the Prognosis of Palmoplantar Pustulosis? (Outcomes/Resolutions)

The prognosis of Palmoplantar Pustulosis depends on its severity. In many cases, the condition is longstanding and resistant to therapy.

Additional and Relevant Useful Information for Palmoplantar Pustulosis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/