II. Pathophysiology

  1. Chronic inflammatory skin disease

III. Epidemiology

  1. Occurs most often in middle aged adults

IV. Risk Factors

  1. Tobacco Abuse
  2. Thyroid disease
  3. Emotional stress
  4. TNF Inhibitor
  5. Streptococcus infection

V. Symptoms

  1. Burning pain and Pruritus on the palms and soles
  2. Painful ambulation due to sole lesions

VI. Signs

  1. Sterile Vesicles and Pustules (2-5 mm) on the palms and soles
  2. Lesions evolve into yellowish-brown to red Macules
  3. Associated findings
    1. Hyperkeratosis
    2. Scaling
    3. Skin fissures
  4. Provocative factors
    1. Metal Allergic Contact Dermatitis

VII. Labs

  1. Potassium Hydroxide stain (KOH Preparation)
    1. Exclude Tinea Pedis or Tinea Manum
  2. Skin biopsy
    1. Confirms diagnosis (not required)

VIII. Differential Diagnosis

IX. Associated Conditions

  1. Psoriasis
    1. Unclear if Palmoplantar Pustulosis is Psoriasis variant or a distinct condition

X. Management

  1. Similar to Psoriasis management starting with high potency Topical Corticosteroids
    1. Typically managed by dermatology
  2. General measures
    1. Skin Lubricants
    2. Avoid topical irritants and allergans
    3. Tobacco Cessation
  3. First-line agents
    1. High potency Topical Corticosteroids (may be ineffective)
    2. Oral Retinoids
    3. Calcipotriene (Donovex)
    4. Photochemotherapy (e.g. PUVA)
  4. Second-line agents
    1. Cyclosporine
    2. Methotrexate

XI. References

  1. Fitzpatrick (1992) Color Atlas Dermatology, p. 52-3
  2. Pesqueira (2019) Am Fam Physician 100(9): 579-80 [PubMed]

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Related Studies

Ontology: Pustulosis of Palms and Soles (C0030246)

Definition (NCI) A chronic inflammatory disorder that generally occurs in adulthood and is characterized by sterile pustules intermingled with scaly erythemas, vesicles and hyperkeratosis occurring at distinct sites on the palms and soles. It is thought to be an autoimmune disorder precipitated by several factors, including local infection, and smoking.
Concepts Disease or Syndrome (T047)
MSH D011565
ICD10 L40.3
SnomedCT 238610005, 27520001
English Palmoplantaris Pustulosis, Pustular Psoriasis of Palms and Soles, Pustulosis of Palms and Soles, Pustulosis Palmaris et Plantaris, Chr palmoplantar pust psorias, Palmoplantar pust psoriasis, Pustular psoriasis palms, sole, Pustulosis palmaris et plantar, PUSTULAR PSORIASIS OF PALMS SOLES, PUSTULOSIS OF PALMS SOLES, palmoplantar pustular psoriasis, palmoplantar pustular psoriasis (diagnosis), acropustulosis, palmoplantar pustulosis, acrodermatitis continua hallopeau, pustulosis palmoplantaris, Acropustulosis (disorder), Acropustulosis, Pustulosis palmaris et plantaris, Pustular acrodermatitis, Chronic palmoplantar pustular psoriasis, PPP - Palmoplantar pustulosis, Palmoplantar pustular psoriasis, Palmoplantar pustulosis, Pustular psoriasis of palms and soles, Pustular psoriasis of the palms AND/OR soles (disorder), Pustular psoriasis of the palms AND/OR soles, pustulosis palmaris et plantaris, psoriasis; pustular, palmaris et plantaris, pustular; psoriasis, palmaris et plantaris, Pustular psoriasis of the palms and soles, Palmoplantar Pustulosis
Dutch palmoplantaire pustulose, psoriasis; pustulosa, palmoplantaris, pustulosa; psoriasis, palmoplantaris, Palmoplantaire pustulose, Pustulaire psoriasis van handpalmen en voetzolen, Pustulose van handpalmen en voetzolen, Pustulosis palmaris et plantaris
German palmoplantare Pustulose, Pustulose der Handflächen und Sohlen, Psoriasis pustulosa palmoplantaris, Pustulosis palmaris et plantaris, Palmoplantar-Pustulose, Pustulöse Psoriasis der Handflächen und Sohlen
Portuguese Pustulose palmoplantar, Pustulose de Palmas e Plantas dos Pés, Psoríase Pustular de Palmas e Plantas dos Pés, Pustulose Palmoplantar
Spanish Pustulosis palmoplantar, psoriasis pustulosa de palmas y plantas, psoriasis pustulosa de las palmas de la mano y las plantas de los pies, pustulosis palmoplantar, soriasis pustulosa de las palmas de la mano y las plantas de los pies, acropustulosis, psoriasis pustulosa palmar Y/O plantar (trastorno), psoriasis pustulosa palmar Y/O plantar, pustulosis palmar y plantar, Palmoplantaris Pustulosis, Psoriasis Pustular de Palmas y Plantas, Pustulosis Palmaris et Plantaris
Japanese ショウセキノウホウショウ, 手掌と足裏の膿疱症, 掌蹠膿疱症, 手掌と足裏の膿疱性乾癬
French Pustulose palmaire et plantaire, Psoriasis pustuleux palmo-plantaire, Psoriasis pustuleux palmoplantaire, Pustulose palmo-plantaire, Pustulose palmoplantaire
Italian Pustolosi palmoplantare, Pustolosi dei palmi e delle piante dei piedi, Pustolosi palmare e plantare, Psoriasi pustolosa dei palmi e delle piante dei piedi
Czech Palmoplantární pustulóza, pustulóza dlaní a chodidel, palmoplantární pustulózní psoriáza, pustulózní psoriáza dlaní a chodidel, pustulózní lupénka dlaní a chodidel
Korean 손,발바닥 고름물집(농포)증
Hungarian Palmoplantaris pustulosis

Ontology: Pustular psoriasis (C0152081)

Concepts Disease or Syndrome (T047)
SnomedCT 200901002, 200973000
English Pustular psoriasis, PSORIASIS PUSTULAR, psoriasis pustular, pustular psoriasis, Pustular psoriasis (disorder), psoriasis; pustular, pustular; psoriasis, Psoriasis pustular
Dutch pustulaire psoriasis, psoriasis pustulair, psoriasis; pustulosa, pustulosa; psoriasis
French Psoriasis pustulaire, PSORIASIS PUSTULEUX
Italian Psoriasi pustolosa
Portuguese Psoríase pustulosa, PSORIASE PUSTULOSA
Spanish Psoriasis pustular, psoriasis pustulosa (trastorno), psoriasis pustulosa
Japanese 膿疱性乾癬, ノウホウセイカンセン
German PSORIASIS PUSTULAER, Psoriasis pustulosa
Czech Pustulózní psoriáza
Hungarian Pustulosus psoriasis, psoriasis pustulosa