Palmoplantar Pustulosis

Palmoplantar pustulosis is a chronic, relapsing inflammatory skin condition characterized by sterile yellow-brown pustules, red patches, and scaling on the palms of the hands and/or soles of the feet. Primarily affecting smokers and middle-aged adults, often females, it causes painful cracking and can severely impact quality of life. While considered a form of pustular psoriasis, it is closely linked to smoking, infection, and sometimes autoimmunity. 

Key symptoms include painful, itching, or burning skin, often accompanied by dry, thickened, scaly patches and painful, deep cracks (fissures) that can make walking or gripping difficult. 

Palmoplantar pustulosis is a chronic, non-contagious skin disorder with an unknown exact cause, but it is heavily linked to smoking (70-90% of cases), genetic factors, and immune system dysfunction. It involves inflammation of the sweat glands on palms and soles, triggered by factors like infection, stress, and specific medications. 

Preventing palmoplantar pustulosis  flare-ups focuses on eliminating triggers, primarily by quitting smoking, which is the most significant risk factor. Effective management includes avoiding skin friction or injury, reducing stress, using soap-free cleansers, and applying heavy emollients to prevent skin fissures. 

Palmoplantar pustulosis  is primarily diagnosed clinically by a dermatologist based on the presence of sterile, yellow-brown pustules,, erythema, and scaly, cracked skin on the palms and soles. Diagnosis involves reviewing medical history (especially smoking habits) and physical exams. Confirmation may involve a skin biopsy (histopathology showing intraepidermal pustules) and a potassium hydroxide (KOH) prep to exclude fungal infections. 

Treatment focuses on managing symptoms—specifically reducing pustules, inflammation, and cracking on palms and soles—using topical steroids, emollients, retinoids (acitretin), and phototherapy. For severe or refractory cases, biologics targeting IL-17, IL-23, or IL-36 pathways and immunosuppressants like methotrexate are utilized. Smoking cessation is critical for success.