What is Palmoplantar Pustulosis?

Our feet experience a lot of use, we use them every day to get from point A to point B. It is a natural occurrence for feet to sustain signs of “wear and tear:” blisters, callouses, dry skin or cuts. These can be painful depending on where they occur. For some individuals with psoriasis, they experience symptoms that can be very uncomfortable and make the occasional blister or callous look like a cake walk.

Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease in which pustules appear on the palms of the hands and the soles of the feet. Some medical experts consider palmoplantar pustulosis a type of pustular psoriasis, while others consider it a separate condition.

With palmoplantar pustulosis (PPP), the skin develops tiny fluid filled blisters (pustules) which can be painful. People with palmoplantar pustulosis may not experience psoriasis anywhere else on their body except for their hands and/or feet. Cracking of the skin is a common symptom with this form of psoriasis, so skin care is important to avoid infection.1

What are symptoms of palmoplantar pustulosis (PPP)

Some of the more common symptoms of PPP include:

  • Dry and thick skin
  • Skin cracking
  • Pustules (fluid filled bumps) and blisters
  • Irritated skin that may be red, tender or itchy

Pressure, rubbing and friction can worsen PPP symptoms. Palmoplantar pustulosis can have a great impact on one’s everyday life including the ability to work and be on one’s feet for long periods of time as well as leisure activities due to the impact of the symptoms. There is usually a progression of symptoms that begin with red or tender skin that may then progress to pustules and blisters and then deep and painful skin cracks. When pustules or blisters weep they may have yellow or white pus. Over time pustules and blisters may dry up which can leave scaled skin spots that may be different skin pigment than the surrounding skin. PPP is more common in women than men, it typically does not occur before adulthood.1

Primary care management

Treatment will not cure PPP, but can often help with symptom control.

  1. Wear comfortable shoes, finding shoes that are made from natural fibers may help as well.
  2. Shoes or inserts with padded soles can also be helpful to avoid additional injury to the skin.
  3. Thick socks can also be helpful to wear as it provides an additional layer of protection.
  4. Avoiding injury to the skin can help to prevent infections.
  5. Cleaning the feet can be an important part of skin care to make sure that cracked skin doesn’t become infected.
  6. Moisturizing the feet is a key part of keeping the skin hydrated to help with avoiding additional cracking. Emollients are often suggested as they work to soften skin and prevent cracking. It can be helpful to ask your dermatologist to recommend a moisturizer.

Once cracks do occur using an adhesive to reduce any additional splitting and to assist with healing may be needed. Community members have used a cyanoacrylate adhesive (AKA superglue) to help hold the skin together. This may be helpful for those who have roles that require standing or being on their feet for most of the day.

Medical treatment options

There are several possible options depending on the severity of the palmoplantar pustulosis.

Topical steroids can be an option to use on the affected skin areas on the foot. Soles of the feet tend to be thicker skin so the topical used may be a higher strength dosage. Typically topical steroids are used for up to a month at a time, your dermatologist will decide if a topical steroid is best for you palmoplantar pustulosis based on an examination of the affected skin.

Topical ointments are another possible treatment option. Some find that applying a topical treatment on the feet before bed and then wrapping the feet with saran wrap and leaving on overnight can help retain moisture.

Light therapy (phototherapy) is a method that utilizes ultraviolet light to slow the production of skin cell growth. Psoralen + UVA (PUVA) or UVB phototherapy can be used in difficult to treat cases of psoriasis and may often be combined with a topical medication. Light therapy can be effective for those who do not have success with creams or ointments. Special light therapy units can be purchased to use on the soles of the feet.

Biologics are medications that work by blocking the immune system response and can be an option for especially difficult cases in which other treatments have not been successful.

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