Management of palmoplantar pustulosis: do we need to change?

Abstract

Palmoplantar pustulosis (PPP) is difficult to treat. There is little hard evidence for the efficacy of any treatment and no published guidelines for its management. A number of exacerbating factors are well documented and there is some evidence for the importance of others. Smoking is the most recognized environmental trigger and recent research has concentrated on the role of eccrine sweat glands in this regard. Other factors, including tonsillar streptococcal infection and gluten sensitivity, may be important in selected cases. The aim of this review is to challenge dermatologists to consider alternative management strategies for PPP and design clinical trials that will enable the development of useful therapeutic guidelines.

442 European consensus statement on phenotypes of pustular psoriasis

“…He was convinced that PPP is a pustular form of psoriasis and as evidence cited the co-incidence of the two conditions, mixed lesions with features of both conditions, familial occurrence and onset triggered by streptococcal infection. Later it was substantiated that tonsillectomy is a beneficial measure in PPP [30]. On the other hand, he strictly set ACH apart from GPP / PPP, as shown in Supplementary Table 1.…”

Palmoplantar pustulosis

“…1 The cause is unknown, and it is unclear whether it is a distinct entity or a localized pustular variant of psoriasis.…”

“…2 Palmoplantar pustulosis is strongly associated with smoking, although smoking cessation may not decrease disease activity. 1 The condition may also be associated with autoimmune thyroid disease, gluten sensitivity and SAPHO syndrome (consisting of synovitis, acne, pustulosis, hyperostosis and osteitis). 1 Topical corticosteroids used under occlusion, psoralen plus ultraviolet A photochemotherapy, and acitretin have shown benefit in treating palmoplantar pustulosis.…”

“…1 The condition may also be associated with autoimmune thyroid disease, gluten sensitivity and SAPHO syndrome (consisting of synovitis, acne, pustulosis, hyperostosis and osteitis). 1 Topical corticosteroids used under occlusion, psoralen plus ultraviolet A photochemotherapy, and acitretin have shown benefit in treating palmoplantar pustulosis. 2 Although the clinical evidence is limited, there is some support for the use of tonsillectomy and for tumour necrosis factor-α inhibitors in treating recalcitrant cases.…”

Palmoplantar pustulosis

“…1 The cause is unknown, and it is unclear whether it is a distinct entity or a localized pustular variant of psoriasis. 1 Palmoplantar pustulosis can be distinguished from dyshidrotic eczema by the presence of pustules (rather than vesicles), and from tinea by a negative finding on direct microscopic examination of potassium hydroxide-treated samples of scale. About 2% to 24% of patients with this condition have evidence of psoriasis elsewhere.…”