Skin Disorders

Skin disorders cover a wide range of conditions, some benign, some very serious, and some even a sign of another underlying illness. A skin disorder not only affects your physical health, but also your emotional well-being.

SkinCare › Skin Disorders › Palmoplantar Pustulosis

Palmoplantar Pustulosis

Palmoplantar pustulosis is a chronic, relapsing eruption limited to the palms and soles and characterized by numerous very typical sterile, yellow, deep-seated pustules that evolve into dusky-red crusts. It is considered by some as a localized form of pustular psoriasis (Barber type) and by others as a separate entity. PPP is also known as pustular psoriasis of the palms and soles because some affected persons also have psoriasis. It sometimes runs in families and rarely occurs before adulthood. Smokers seem to be especially prone to PPP.

Causes of Palmoplantar pustulosis

The pustules are sterile pustules; there are no germs in them and they are not contagious. They come in waves or crops on one or both hands and/or feet. They are associated with thickened, scaly, red skin that easily develops painful cracks (fissures). It is not caused by any known allergy or food.

The condition varies in severity and may persist for many years. It is not known what triggers flare-ups. It has little effect on the health in general, but can be very uncomfortable. Usually, pressure, rubbing and friction will worsen PPP.

Signs and symptoms of Palmoplantar pustulosis

Skin lesions :- Pustules in stages of evolution, 2 to 5 mm, deep-seated, develop into dusky-red macules and crusts; present in areas of erythema and scaling or normal skin. Eruptions come and go, in waves.

Distribution Limited to palms and soles, may be only a localized patch on the sole or hand, but may involve both hands and feet with a predilection of thenar and hypothenar, flexor aspects of fingers, heels, and insteps; acral portions of the fingers and toes usually spared

Palmoplantar pustulosis Diagnosis

KOH Preparations - To exclude dermatophytosis

Bacterial and Viral Culture To exclude Staphylococcus aureus infection and HSV infection if lesions are localized to one site.

Dermatopathology Edema and exocytosis mononuclear cells that appear first form a vesicle, and later myriads of neutrophils, ' form a unilocular spongiform pustule and acanthosis

Treatment for Palmoplantar pustulosis

The condition is recalcitrant to treatment, persistence in treatment can be rewarding.

PUVA "Soaks" of Hands and Feet Idea this condition. The hands and feet are immersed in a solution of 8-methoxypsoralen (10 mg/L warm water) for 15 min and then exposed to special hand and foot UVA phototherapy units. Re-PUVA is highly efficacious.

Topical Glucocorticoids. Dithranol, and Coal Tar Ineffective. Strong glucocorticoids under plastic occlusion (e.g., for the night) may effective, but do not prevent recurrences. Methotrexate for recalcitrant cases.

Ultraviolet light, with or without an oral medication called oxsoralens (PUVA), is very effective for those who do not improve with creams and ointments. It is usually given in the doctor's office three times per week. Burns, sometimes enough to blister the skin, occasionally occur.

Tips on preventing and treating Palmoplantar pustulosis

• Choose comfortable footwear made from natural fibres.
• Avoid friction and minor injuries.
• Wash with bath oil or soap substitute.
• Cover deep fissures with a waterproof dressing.
• Rest the affected area.