Pustulosis palmaris et plantaris

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.