Palmoplantar pustulosis is a chronic autoimmune disease that affects the palms of the hands and/or soles of the feet. The patient develops various painful and itchy ulcers, pustules or blisters on the affected areas. As a result, the patient is no longer able to perform certain leisure or occupational activities (walking, using tools, etc.). The symptoms of the condition can be alleviated with some treatments, although many patients do experience flare-ups.

• Synonyms of palmoplantar pustulosis
• Causes: Autoimmune disorder
• Risk factors of skin condition

• Disease
• Flare-ups

• Associated conditions
• Symptoms
• Diagnosis and examinations
• Therapy

• Reduce complaints
• Suppress the immune system

• Prognosis
• Complications
• Prevention

Synonyms of palmoplantar pustulosis

Palmoplantar pustulosis (PPP) has some other terms in the medical literature such as:

• chronic recalcitrant vesiculo-pustular acral dermatitis
• palmoplantar pustulosis
• palmoplantar pustular psoriasis
• pustulosis palmaris et plantaris
• Andrews-Barber disease

Causes: Autoimmune disorder

Palmoplaintary pustulosis is a non-contagious autoimmune condition in which the immune system mistakenly attacks healthy skin cells of the hands and feet. The exact cause is not known, but several risk factors have been identified that contribute to the development of the condition.Smoking leads to the disease more quickly and also to flare-ups of the condition / Source: Geralt, Pixabay

Risk factors of skin condition

Disease

Common risk factors for palmoplantar pustulosis include:

• the presence of another autoimmune disease
• a family history of palmoplantar pustulosis
• a family history of psoriasis (chronic skin disease with dry skin and flakes)
• a history of smoking
• Gender: Women are affected more often than men
• smoking

Flare-ups

The flare-ups of palmoplantar pustulosis occur more quickly due to the following factors:

• the use of some medications, such as steroids
• infections, especially streptococcal infections (type bacteria)
• smoking
• tension

Associated conditions

There may be a connection between psoriasis and palmoplantar pustulosis. According to certain scientists, patients with palmoplantar pustulosis have a higher chance of developing a form of psoriasis where they regard palmoplantar pustulosis as a separate entity. Other scientists report that palmoplantar pustulosis is a form of psoriasis. Celiac disease (stomach and intestinal problems caused by eating gluten), thyroid disorders and diabetes mellitus type 1 (all autoimmune diseases), tonsillitis (inflammation of the tonsils) caused by streptococcal bacteria and the SAPHO syndrome (synovitis-acne-pustulosis-hyperostosis-osteomyelitis ) are also more common in patients with palmoplantar pustulosis.

Symptoms

The patient develops symptoms on both palms and/or soles of the feet that are different for each patient. In most patients, symptoms begin with softer and red skin on the hands and palms. Fluid-filled pustules, blisters and skin ulcers (pustules) form on the red areas and often burst. The often painful and itchy skin lesions are filled with white or yellow pus and come and go. They dry out, causing brown, flaky, cracked (cracked skin), thickened and dry skin. When pimples appear on the feet, walking is made more difficult. Other physical activities also often pose problems for patients with palmoplantar pustulosis. For example, certain occupations that require the patient to use their hands or walk a lot are not advisable for patients with the skin condition.

Diagnosis and examinations

The doctor examines the patient’s skin and examines the skin lesions. He also asks about family history of psoriasis or palmoplantar pustulosis, as well as whether other possible risk factors are present. Furthermore, a skin scraping or skin biopsy is required. The doctor wants to rule out infections and conditions with a similar clinical picture.

Therapy

Moisturizer may relieve complaints / Source: Kiyok, Wikimedia Commons (CC BY-SA-3.0)

Reduce complaints

There is no proven effective treatment for palmoplantar pustulosis in October 2020. The condition is difficult to treat because the symptoms come and go in many patients. However, it is possible to alleviate the symptoms. Some common treatment options include:

• phototherapy (treatment via light)
• oral (taken by mouth) retinoids
• topical (applied to the skin) steroid creams or ointments
• topical tar ointment
• moisturizers

The complaints do not always decrease with treatment; Sometimes the patient must therefore try several treatments or else a combination of treatments is necessary before the skin lesions and associated signs diminish.

Suppress the immune system

The doctor may also use medication to reduce the activity of the immune system, such as methotrexate, cyclosporine or immunosuppressive therapy (treatment aimed at suppressing the immune system).

Prognosis

The condition is chronic and flare-ups occur. The patient therefore has quieter periods that are followed by new blistering on the hands or feet. However, not all patients experience flare-ups as some patients experience only one episode of symptoms and then never return. Typically, lifestyle changes and some preventative steps help to reduce the frequency and severity of flare-ups.

Complications

Blisters, ulcers and other skin lesions on the hands and/or feet sometimes cause several complications that lead to a reduced quality of life, such as:

• scratching or intense itching of the hands and feet (due to the itching)
• problems with walking or other activities that require the patient to move
• sleep problems due to the pain

Prevention

By taking some measures it is possible to reduce the severity and frequency of flare-ups. This is possible by:

• avoid bath foam and shower gels
• keep affected skin areas clean
• rest the hands and feet often
• protect the skin against chemicals, water and possible irritants
• avoid injury to the skin
• use a moisturizing soap
• wear cotton socks
• using salicylic acid or urea creams on the feet to prevent cracks
• Avoid shoes made from synthetic products
• to quit smoking

read more

• Skin rash on palm: Causes, symptoms and treatment
• Blisters: Causes and treatments of blistering skin
• Foot pain: Causes of sore foot or foot pain
• Hand pain: Causes and symptoms of a painful hand
• Vesicles (blisters) on hands and feet: Causes of blister formation