Palmoplantar pustulosis: Epidemiology, clinical features, and diagnosis
- Giovanna Brunasso, MD
Giovanna Brunasso, MD
- First Level Medical Director
- Department of Dermatology
- Galliera Hospital
- Cesare Massone, MD
Cesare Massone, MD
- Medical Director, Dermatology Unit
- Galliera Hospital, Genova, Italy
- Associate Professor, Department of Dermatology
- Medical University of Graz, Graz, Austria
Palmoplantar pustulosis (PPP) is a chronic inflammatory condition characterized by crops of sterile pustules on the palms and soles that erupt repeatedly over time (picture 1A-F). Yellow-brown macules (remnants of resolving pustules), erythema, scale, and fissures are additional frequent findings. Other terms that have been used to refer to PPP are palmoplantar pustular psoriasis, pustulosis palmoplantaris, and pustulosis palmaris et plantaris.
Despite the limited area of skin involvement in PPP, the condition can have a significant negative effect on quality of life. Symptoms of pruritus, burning sensations, or pain are often present. In severe cases, the discomfort associated with skin involvement can cause difficulty with walking or other activities of daily living.
The clinical features, diagnosis, and management of PPP will be reviewed here. Other pustular disorders, including acrodermatitis continua of Hallopeau (an acral variant of pustular psoriasis that primarily involves the digits) are reviewed separately. (See "Palmoplantar pustulosis: Treatment" and "Approach to the patient with pustular skin lesions" and "Pustular psoriasis: Pathogenesis, clinical manifestations, and diagnosis" and "Pustular psoriasis: Pathogenesis, clinical manifestations, and diagnosis", section on 'Acrodermatitis continua of Hallopeau' and "Neutrophilic dermatoses".)
Authors who consider PPP a subtype of psoriasis have done so based upon the recognition of similarities between the conditions. As an example, our retrospective study comparing 39 patients with PPP and 51 patients with palmoplantar plaque psoriasis (a non-pustular form of psoriasis characterized by erythematous scaly plaques on the palms and soles) did not find statistically significant differences in age of onset, disease duration, family history of psoriasis, concomitant arthritis, or smoking habits between the two groups . In addition, erythematous, scaly plaques similar to those of palmoplantar plaque psoriasis frequently accompanied pustules in PPP.
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- CLINICAL MANIFESTATIONS
- Cutaneous manifestations
- Associated clinical findings
- ASSOCIATED DISORDERS
- SAPHO syndrome
- Systemic diseases
- DISEASE COURSE
- History and physical examination
- Potassium hydroxide preparation
- Bacterial culture
- Skin biopsy
- - Histopathology
- Laboratory studies
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS