Pustulosis palmaris et plantaris

Pustulosis palmaris et plantaris (PPP), also known as palmoplantar pustulosis or palmoplantar pustular psoriasis, is a chronic inflammatory skin condition characterized by the recurrent eruption of sterile pustules on the palms of the hands and soles of the feet. Classified under the ICD-10 code L40.3, it is considered a localized form of pustular psoriasis, though its exact relationship to plaque psoriasis remains debated. The condition primarily affects the skin, with lesions typically appearing as crops of yellow-white pustules on an erythematous (reddened) base, often accompanied by scaling, fissuring, and thickening of the skin. These symptoms can cause significant pain, itching, and functional impairment, substantially reducing quality of life. The disease follows a chronic relapsing-remitting course and is most commonly seen in middle-aged adults, with a notable female predominance. Smoking is a well-established risk factor and exacerbating influence. PPP is also strongly associated with osteoarthritis of the anterior chest wall (sternocostoclavicular hyperostosis or SAPHO syndrome). The pathogenesis involves immune dysregulation, with involvement of both innate and adaptive immune pathways, including IL-17 and IL-36 signaling. Treatment of PPP can be challenging, as the condition is often resistant to conventional therapies. First-line approaches include potent topical corticosteroids, topical vitamin D analogues, and phototherapy (particularly PUVA therapy targeted to the palms and soles). For moderate-to-severe or refractory cases, systemic treatments such as acitretin, methotrexate, cyclosporine, and biologic agents (including IL-23 inhibitors and TNF-alpha inhibitors) may be considered, though response rates vary. Smoking cessation is strongly recommended as part of the management plan.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

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