Pustulosis palmaris et plantaris

Pustulosis palmaris et plantaris
Synonyms	Pustulosis of palms and soles, Palmoplantar pustulosis, Persistent palmoplantar pustulosis, Pustular psoriasis of the Barber type, and Pustular psoriasis of the extremities
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Field
Symptoms
Complications
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Duration
Types
Causes
Risks
Diagnosis
Differential diagnosis	SAPHO syndrome
Prevention
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Deaths

Alternate names

Palmoplantar pustulosis; LPP; PPP; Localized pustular psoriasis

Definition

Pustulosis palmaris et plantaris (PPP) is a rare and chronic inflammatory condition that primarily affects the palms of the hands and soles of the feet. The classification of PPP is controversial. Some have proposed that PPP is a variant of psoriasis, while others believe it to be a separate disease.

Cause

• The cause of pustulosis palmaris et plantaris (PPP) is not fully understood, though many theories have been proposed. Some have suggested PPP may be a disorder of the sweat glands.
• Environmental factors are believed to play a part as well.
• For instance, there is a strong association between smoking and PPP.
• Other environmental factors that may contribute to PPP include stress, infections (especially tonsillitis and sinusitis), and certain medications. Some have also suggested an association with allergies to certain metals.
• Although most cases occur in people with no family history of the condition, more than one family member can be affected.
• This suggests that genetic factors may contribute to the development of the condition in some cases.

Signs and symptoms

• Signs and symptoms of the condition generally develop during adulthood and include crops of pustules on one or both hands and/or feet that erupt repeatedly over time.
• Affected individuals may also experience itching (pruritus), pain, or a burning sensation.
• Though the area of involvement is often limited, PPP can have a significant effect on quality of life and can interfere with walking or other daily activities.

Diagnosis

A diagnosis of pustulosis palmaris et plantaris (PPP) was made by histopathological examination that reveals hyperkeratosis with orthoheratosis, acanthosis, spongiosis and papillomatosis. A subgranular pustule, filled with polymorph nuclear neutrophils, was also observed within the epidermis. .

Treatment

• Although there is no cure for pustulosis palmaris et plantaris, various measures may be useful to manage symptoms.
• General suggestions include smoking cessation and emollients (non-cosmetic moisturizers) to soften dry skin and prevent cracking.
• Topical corticosteroids (steroids), an oral retinoid such as acitretin, and photochemotherapy (ultraviolet radiation treatment) are often first-line treatments.
• Other methods that may be utilized when initial treatment options fail include a combination of oral retinoid and photochemotherapy or immunosuppressive therapy with medications such as cyclosporine.