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Updated: 6/18/2021

Pustulosis Palmoplantaris

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  • summary
    • Pustulosis Palmoplantaris, also known as pustular psoriasis, is an idiopathic skin condition commonly seen in smokers, that presents with crops of sterile pustules that occur on one or both hands and feet.
    • Diagnosis is one of exclusion and is made with the presence of 1 to 10 mm sterile pustules on palms or feet with surrounding erythema and fissures. No serological tests are specific for disease.
    • Treatment is usually general measures such as smoking cessation, avoiding skin irritants, and medical management with topical corticosteroids.
  • Epidemiology
    • Demographics
      • more common in middle-aged men than in women
      • rare in children
    • Risk factors
      • the majority of patients are smokers (65–90%)
      • increased stress
      • infection (i.e acute or chronic tonsillitis)
      • drugs (i.e.TNF-alpha inhibitors)
  • Etiology
    • Pathophysiology
      • unknown
        • therories
          • activated nicotine receptors in the sweat glands cause an inflammatory process
    • Associated conditions
      • orthopaedic conditions
        • chronic recurrent multifocal osteomyelitis
        • synovitis–acne–pustulosis–hyperostosis–osteomyelitis (SAPHO) syndrome
          • rare presentations of arthropathy
      • medical conditions & comorbidities
        • autoimmune diseases
          • gluten sensitive enteropathy (celiac disease)
          • thyroid disease
          • type 1 diabetes
  • Presentation
    • Symptoms
      • pruritis, bruning sensation and occasionally pain
      • worsend by pressure, rubbing and friction
      • may have discomfort walking
      • significant psychologic effect
    • Physical exam
      • inspection
        • 1 to 10 mm sterile pustules on palms +/- soles of feet
        • surrounding erythema and fissures
        • usually bilateral
      • motion
        • joint pain suggestive of SAPHO
  • Studies
    • Labs
      • no serological tests are specific for disease
      • laboratory tests for bacterial infection are negative
    • Biopsy and diagnositc injections
      • skin biopsy may be helpful but is rarely necessary
  • Treatment
    • Non-operative
      • general measures
        • smoking cessation
        • skin moiturization
        • avoidance of irritants
      • topical corticosteroids, oral retinoid, photochemotherapy
        • indications
          • first-line therapy
        • outcome
          • slow-risk for adverse effects with topical corticosteriod therapy
  • Prognosis
    • Not contagious
    • Varies in severity and can persist for many years
    • Little effect on general health
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