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Medical News Today: What is palmoplantar pustulosis?

Palmoplantar pustulosis is an autoimmune disorder marked by the appearance of fluid-filled pustules or blisters on the hands and feet.

Autoimmune disorders cause the immune system to attack healthy cells. In the case of palmoplantar pustulosis, the immune system attacks the healthy skin on the hands and feet.

Palmoplantar pustulosis, or PPP, is a chronic condition. This means that a person is likely to develop new blisters on the hands or feet after a previous flare has cleared up. However, not everyone will experience a recurrence of the condition.

The pustules that form are often painful and itchy. The blisters often crack open. When pustules appear on the feet, it can make walking and other physical activities more difficult for someone.

However, there are treatments available that may help relieve the pain and itching and reduce the number of the palmoplantar pustulosis flares a person has.

Symptoms

woman scratching the palm of her hand
Palmoplantar pustulosis affects the hands and feet, causing itching, cracked skin, and blisters.

The symptoms of palmoplantar pustulosis often vary. The most common symptom for people with palmoplantar pustulosis is sores that develop on the hands and feet.

Some other common symptoms a person may experience include:

  • small blisters on the hands or feet, often with yellow pus
  • cracked skin
  • tender, red skin
  • itchiness
  • scaly skin
  • pain
  • dry skin
  • thick skin

For most people, symptoms start with their skin becoming tender and red on their hands and palms. The red areas eventually form pustules that may appear as patches on the skin. The pustules are often filled with a white or yellow liquid.

It is typical for the pustules to come and go. As they dry, the skin typically turns brown and dries, leading to cracks forming.

Depending on the exact location of the pustules, palmoplantar pustulosis can be painful and make everyday activities more challenging.

Causes and risk factors

palmoplantar pustulosis on foot
Palmoplantar pustulosis can cause the skin to become red and tender and develop painful cracks.

Researchers are still not sure of the exact causes of palmoplantar pustulosis. They have, however, identified several risk factors that may contribute to a person developing this disorder.

Common risk factors include:

  • smoking
  • history of smoking
  • family history of psoriasis
  • presence of another autoimmune disorder
  • family history of palmoplantar pustulosis

Palmoplantar pustulosis is more common among women than men.

Also, there are some common causes of flare-ups. Factors that may trigger a flare include:

  • smoking
  • infections, especially streptococcal bacteria infections
  • stress
  • some medications, such as steroids

Similarly to psoriasis, palmoplantar pustulosis cannot be spread between people.

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Associated conditions

Some researchers believe there is a connection between psoriasis and palmoplantar pustulosis.

Most scientists agree that there is a chance a person who has palmoplantar pustulosis may also have a form of psoriasis.

However, some believe that palmoplantar pustulosis is a form of psoriasis while others think it is a separate condition.

Diagnosis

To diagnose palmoplantar pustulosis, a doctor will need to examine the person’s skin and the blisters that have formed. The doctor will likely ask about family history of psoriasis or palmoplantar pustulosis.

Some additional tests may be required to rule out other conditions, including infections, that present similar symptoms. Tests may include:

  • a swab or scrape of the skin
  • skin biopsy

The samples collected by these tests will be examined in the laboratory.

Usually, the scraping of skin is painless. If another infection is found, the doctor will treat the person for the illness and it should heal. A skin biopsy often requires stitches and local anesthesia.

Treatment

Unfortunately, there is currently no cure for palmoplantar pustulosis. It is often difficult to treat because the symptoms can come and go.

Treatment plans usually focus on managing the symptoms when they occur. Some common treatment options include:

  • steroid creams or ointments
  • tar ointments
  • oral retinoids
  • light therapy
  • moisturizing creams

Additional treatment options are available if some of the above fail to work. A doctor may also prescribe the following to reduce the activity of the immune system:

  • methotrexate
  • cyclosporine
  • immunosuppressive therapy

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Complications

Palmoplantar pustulosis can cause some additional complications. The most common of these include:

  • scratching or an intense itch on the hands and feet
  • trouble walking or other activities that involve moving
  • pain that affects a person’s sleep

These complications can negatively impact on someone’s quality of life and make everyday activities difficult or nearly impossible to do.

Management tips

womans legs in bubble bath
Avoiding bubble baths may help reduce the risk of palmoplantar pustulosis flares.

Palmoplantar pustulosis cannot be cured or necessarily prevented. However, there are steps that a person can take to reduce the severity of flares or the number of times it appears.

Some options that may help manage palmoplantar pustulosis include:

  • using a moisturizing soap
  • avoiding bubble baths and shower gels
  • quitting smoking
  • avoiding injury to the skin
  • keeping affected areas of skin clean
  • protecting the skin from chemicals, water, and potential irritants
  • wearing cotton socks
  • resting hands and feet often
  • using salicylic acid or urea creams on the feet to avoid cracks
  • avoiding shoes made from synthetic products

Outlook

Palmoplantar pustulosis is an incurable autoimmune disorder. It is associated with flares that can come and go over a person’s lifetime.

Treatment is focused around relieving the symptoms. Although flares cannot be predicted, it is possible that some lifestyle changes and preventive steps may be useful in helping a person reduce the severity or frequency of symptoms.

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