Pustulosis Palmaris et Plantaris

We report an 81-year-old male with long lasting psoriasis with exacerbation who showed remission of skin lesions after cholecystectomy. He consulted our clinic for impetiginous skin lesions and was treated with oral antibiotics without improvement. Several days later, he developed right hypochondralgia and was diagnosed with acute cholecystitis with gallstones. After cholecystectomy, the skin lesions significantly improved and disappeared within three weeks. Laboratory examination data indicated that acute inflammatory parameters normalized simultaneously. Although the role of focal infection in psoriasis is obscure, our case emphasizes the importance of focal infection in the pathogenesis of unstable psoriasis.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Remission of Pustular Psoriasis after Cholecystectomy: Role of Focal Infection in Pustularization of Psoriasis

Nomura

Mizutani

Inachi

et al. 1995

“…There is no definitive method of treatment for pustulosis palmaris et plantaris (PPP), although corticosteroid therapy and removal of foci based on focal infection therapy are two of the methods that have been employed. The removal of foci, especially the tonsils, was advocated by Andrews (I) and many other investigators (2,3), while Sachs (4), Hellgren (5) and others have expressed negative views on the usefulness of this therapy. The fact that some cases improve after the removal of foci is not disputed.…”

mentioning

confidence: 99%

Evaluation of Tonsillectomy as a Treatment for Pustulosis Palmar1s Et Plantaris

Ono

1977

Self Cite

Two hundred and eighty five cases of pustulosis palmaris et plantaris (PPP), of which 73 cases (25.6%) underwent tonsillectomy, were studied to evaluate the effectiveness of tonsillectomy as a treatment for PPP. The group of tonsillectomized patients showed significantly better results than a group which received other methods of treatment. A tendency to leukocytosis was observed in PPP which normalized, in many cases, after tonsillectomy. The shorter the period between the onset of PPP and tonsillectomy the better the results, and the quicker the response. A transient worsening of PPP after tonsillectomy did not after the prognosis. In order to determine if tonsillectomy was indicated, an ultrashort wave direct provocation test was conducted in which ultrashort wave was applied to the tonsil. Leukocytosis and worsening of PPP after the test was considered as an indication for tonsillectomy. In some cases, there were considerable changes in plasma cortisol levels and NBT test values after the provocation test. Improvement of PPP after the Impretol test (one of the annulation tests) in which Impretol was injected into the tonsil, appears to support the focal infection origin of PPP in these cases. There is a possibility that the Impretol test could be used as a treatment for PPP.

Orthopedic Symptoms in Pustular Bacterid (Pustulosis Palmaris Et Plantaris): Tietze's Syndrome and Arthritis of Manubriosternal Joint Due to Focal Infection

Ishibashi

Nishiyama²,

Endo

et al. 1977

Painful orthopedic symptoms in the sternal area, such as arthritis of the manubriosternal and sternoclavicular joint or Tietze's syndrome, were found in 14 of 132 cases of pustulosis palmaris et plantaris. The majority of the pustulosis palmaris et plantaris patients with orthopedic symptoms had skin eruptions not only on the palms and soles, but also on the backs of the hands and feet, the arms, the legs and the trunk. Such cases were usually accompanied by elevation of the erythrocyte sedimentation rate, leucocytosis, changes in serum globulin, and also pyrexia at the time of exacerbation. The skin and orthopedic symptoms often worsened after acute exacerbation of the focal infection, and occasionally responded to tonsillectomy or chemotherapy with antibiotics, which is suggestive of the probable cause of the bacterid.