Palmoplantar pustulosis: a clinical and immunohistological study

Abstract

Pustulosis palmoplantaris (PPP) is a common chronic skin disease, which is very resistant to treatment. It is not known why the lesions are located in the palms and soles. There are few studies of the disease and in particular studies of the histology. Fifty-nine patients with PPP answered a questionnaire concerning their medical history and 39 of them were clinically examined. Biopsy specimens were taken from involved skin in 22 of the 39 patients and studied immunohistologically for tryptase+ mast cells, EG2+ eosinophils, lipocalin+ neutrophils and CD3+ T lymphocytes. The sweat gland and sweat duct were visualized with AE1/AE3 antibody (cytokeratins 1-8, 10, 14/15, 16, 19). In addition to neutrophils in the pustule and lymphocytes in the upper dermis, there were also large numbers of mast cells and eosinophils in the subpustular area. Numerous eosinophils were present in the pustule. The epidermal part of the eccrine duct was not detectable in any of the specimens from patients with PPP but was present in all of the nine control persons (including two smokers). The results indicate that the acrosyringium is involved in the inflammation and also that mast cells and eosinophils participate in a hitherto unknown way. Of the 39 patients clinically examined, two had previously diagnosed thyroid disease and two had gluten hypersensitivity. Seventeen had one or several abnormal serum concentrations of thyroid-stimulating hormone, thyroxin, antibodies against thyroglobulin or thyroperoxidase and 10 had immunoglobulin (Ig) A antibodies to gliadin. The mean +/- SD for serum IgA and for eosinophil cationic protein was increased. From the questionnaire the most notable finding was that 56 of the 59 patients had been or still were smokers, all of whom had started smoking before the first signs of PPP. We hypothesize that the acrosyringium might be the target for the inflammation and that PPP is linked to autoimmune thyroid disease and smoking.

IL-8 as Antibody Therapeutic Target in Inflammatory Diseases: Reduction of Clinical Activity in Palmoplantar Pustulosis

“…In PPP, accumulation of activated neutrophils and elevated levels of IL-8 in lesional areas are prominent (19,20,45). We herein confirm increased production of IL-8, as well as the closely related CXC chemokine Gro-␣, to be typical for PPP compared with a number of other cytokines and chemokines (such as MIG and IL-6), which are also elevated in eczema, and TNF-␣, being only moderately elevated in PPP.…”

Dermatoses neutrofílicas: parte II

“…70 Some studies have shown the presence of an abnormal portion of the acrosyringium in the epidermis of patients with PPP, suggesting its participation in the etiopathogenic process of pustule formation. 60 Furthermore, nicotinic receptors expression is altered in the epidermis of patients with PPP, and nicotine would lead to an inflammatory response with altered expression of acetylcholinesterase (acetylcholine degrading enzyme), resulting in lesions of PPP. 70 The triggering mechanism of inflammation is unknown.…”

“…In general, the disease is persistent and painful, causing the functional impairment of patients. [59][60][61][62] Because PPP shares some common features with pustular psoriasis, some authors consider it a localized form of this disease.…”

“…82 There is evidence of the presence of mastocytosis with eosinophilia underneath the pustules; however, neutrophils and eosinophils are found inside the pustules. 60,71 Factors already established as potential triggers of palmoplantar pustulosis, such as infectious or allergic processes, should be appropriately investigated and treated. 72 Moreover, there is evidence that female patients with PPP have lower rates of bone mineral density, thus being at risk for the development of osteoporosis.…”

“…It is more common in places with hot and humid climate. [59][60][61] The prevalence of patients with PPP and classic psoriasis is about 10% . 50 Lesions are characterized by the presence of sterile pustules in the palmoplantar region, over apparently normal skin or skin with erythema and desquamation (Figure 3).…”