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What Is Palmoplantar Pustulosis?

Last updated: October 2023

Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease that causes pustules (small inflamed bumps) on the palms of the hands, the soles of the feet, or both. PPP is also called palmoplantar pustular psoriasis or localized pustular psoriasis.1-3

Some experts classify PPP as a type of psoriasis. But others consider it a separate condition. PPP may occur with or without psoriasis.1-3

What causes palmoplantar pustulosis?

The exact cause of PPP is unknown, but research has found that some factors may increase a person's risk of the condition or make existing cases worse. These factors include:1,2

  • Smoking – Most people with PPP are current or past smokers
  • Infections – Bacterial infections like tonsillitis, chronic sinus infections, or dental infections have been linked to PPP
  • Stress – Studies have found that stress worsens symptoms of PPP in people with the condition
  • Medicines – Certain biologic drugs used to treat inflammatory conditions like psoriasis and rheumatoid arthritis have been linked to the development of PPP
  • Metal allergies – Some researchers have found that people with PPP are allergic to metals like nickel, chromium, and mercury
  • Family history – Those with a family history of PPP or psoriasis may be more likely to also develop PPP

What are the symptoms of palmoplantar pustulosis?

The hallmark symptom of PPP is pustules that may contain fluid or pus. These pustules may occur on only the palms of the hands or only the soles of the feet, but most people have pustules in both areas.1,2

The pustules usually darken and turn brown as they dry. Next, scaly patches form in the area of the dried pustules, and the affected skin may crack or split. The skin may also feel painful, itchy, and like it is burning.1-3

PPP symptoms vary in severity and may last for years. People with the condition may experience flares followed by periods of few to no symptoms.1,2

Over time, PPP also often causes nail changes. These may include pustules under the nails, pitting, nail discoloration, and separation of the nail plate from the nailbed.1,2

PP symptoms can make it hard for people to walk or do tasks with their hands or feet.1-3

How is palmoplantar pustulosis treated?

There is no cure for PPP, but treatments may improve symptoms. First-line treatments include:2,4

  • Topical steroids – Strong steroid creams may be applied directly on pustules. Doctors usually recommend that the treated area is then covered with a hydrocolloid dressing.
  • Oral retinoids – Retinoids are a group of medicines related to vitamin A. They slow rapidly growing skin cells and reduce redness and swelling. Retinoids are often used to treat inflammatory skin conditions, including psoriasis and acne.
  • Light therapy (phototherapy)Light therapy uses ultraviolet light to slow the production of skin cells. Psoralen plus ultraviolet A (PUVA) is the most common form of light therapy used to treat PPP.

Doctors may use a combination of treatments to improve PPP symptoms in people who do not respond to first-line therapies. Severe cases of PPP may be treated with certain biologic drugs, which work by blocking the immune system response.2,4

Since PPP is more common in people who smoke, quitting smoking may also improve PPP symptoms.2,4

Tips for living with PPP

Living with PPP can be challenging, but there are things you can do to help manage the condition and make symptoms more tolerable. These include:4,5

  • Choose comfortable shoes and socks that are made from natural fibers, such as cotton
  • Use gentle soaps and detergents
  • Wear gloves when doing tasks like gardening or manual labor
  • Apply a thick, unscented emollient moisturizer on affected areas often
  • Avoid activities that may cause friction, minor injuries, or infections on the hands and feet
  • Find ways to manage your stress, since stress can worsen PPP symptoms

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