Palmoplantar pustulosis is a rare autoimmune skin condition. Blisters and pus-filled bumps, known as pustules, appear on the palms of the hands and the soles of the feet. It’s chronic and more likely to affect current or former smokers.

Palmoplantar pustulosis is considered a type of pustular psoriasis by some experts and a separate condition by others.

The condition is rare, with a prevalence of only about 0.01% to 0.05%. When it does develop, it can affect the quality of your life. It can be a painful condition causing itchiness and skin cracks. It can also make walking or other activities difficult.

Read on to learn more about what it feels and looks like, as well as its symptoms, causes, and treatment.

Palmoplantar pustulosis is more common in adults than in children, within a mean onset age range of 40 to 58.

The symptoms can vary. Most people with this condition have problems with the skin on their hands and feet.

The most common symptoms include:

  • red and tender skin
  • blisters and pustules (pus-filled bumps) on the palms of the hands and the soles of the feet
  • itchiness
  • pain
  • skin cracks
  • scaly skin
  • dry and thick skin

The first symptom is red and tender skin on the palms of the hands and the soles of the feet. Then, blisters and pustules form. The pustules can appear in patches on the skin. They can start as a small area and spread. It’s common for them to come and go.

The pus in the pustules can be white or yellow. After the blisters and pustules dry up, they can turn brown and scaly. Deep and painful cracks can form in the skin. The skin can also become dry and thick.

Since the condition is so rare, there haven’t been many reports on how it looks on skin of color. Generally, psoriasis may appear more purple on darker skin, and the person can experience more hyperpigmentation.

The exact cause of palmoplantar pustulosis is unknown. However, several factors may contribute to the development of this condition.

You’re more likely to have palmoplantar pustulosis if you:

  • currently smoke
  • used to smoke
  • have a history of psoriasis
  • have a family history of palmoplantar pustulosis or other types of psoriasis
  • have another autoimmune disease, such as celiac disease, thyroid disease, arthritis, or type 1 diabetes

Triggers for flare-ups of palmoplantar pustulosis include:

  • streptococcal bacterial infections
  • other types of infections
  • stress
  • certain medications, such as steroids
  • smoking

Another trigger for palmoplantar pustulosis or pustular psoriasis is a type of medication called TNF-alpha inhibitors. Typically doctors use these to treat psoriasis, but they can actually cause flares of this type of psoriasis.

Palmoplantar pustulosis isn’t contagious and can’t be spread to other people.

Some medical experts consider palmoplantar pustulosis a type of pustular psoriasis. Others view it as a separate condition. If you have palmoplantar pustulosis, you’re more likely to have other types of psoriasis.

Risk factors

According to a 2017 article, palmoplantar pustulosis is more common in females than males. In fact, between 60% and 90% of people affected are female.

The most common risk factors include:

  • being female
  • being an older adult
  • currently smoking or having a history of smoking

Language matters: Sex and gender

In this article, “male” and “female” have been used to reference sex rather than gender. These terms have been used to correspond with the language used in the cited research.

People often use the terms sex and gender interchangeably, but they have different meanings:

  • “Sex” refers to the physical characteristics that differentiate male, female, and intersex bodies.
  • “Gender” refers to a person’s identity and feelings. Examples of words used to describe gender identity include “man,” “woman,” “nonbinary,” “agender,” “bigender,” “genderfluid,” “pangender,” and “trans.” A person’s gender identity may differ from the sex they were assigned at birth.
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The diagnosis process for palmoplantar pustulosis starts by looking at your skin. A doctor will examine the skin on your palms and soles to check for blisters or pustules. They may need to do several tests and gather more information to rule out other medical problems.

These tests and information include:

  • physical exam and medical history
  • skin biopsy
  • swab or scrape of the skin to check for infections
  • laboratory tests to check for infections or elevated biomarkers, such as C-reactive protein (CRP) and uric acid levels

Learn if a skin biopsy can confirm psoriasis.

A swab or scrape of the skin is usually painless. A skin biopsy may be necessary to rule out other problems. This usually requires a local anesthetic and stitches to close the wound from the biopsy.

Palmoplantar pustulosis is sometimes difficult to treat. This condition can come and go. It’s common for it to disappear and reappear over a long period.

There’s no cure for palmoplantar pustulosis. Treatment may help you manage the symptoms, however. The most common treatments include:

  • topical steroids in the form of creams and ointments
  • skin-moisturizing creams and ointments
  • tar ointments
  • oral retinoids such as acitretin
  • phototherapy or ultraviolet light therapy (PUVA)

If those treatments don’t work, a doctor may recommend other treatments, including:

Palmoplantar pustulosis can be resistant to treatment. It may take months to find the right treatment plan for you.

Palmoplantar pustulosis is an autoimmune condition. This means that the body’s immune system attacks itself. The most common complications include the following:

  • joint stiffness
  • difficulty walking or doing daily tasks
  • pain that affects sleep
  • infection from scratching your itchy palms and soles

It may not be possible to prevent all cases of palmoplantar pustulosis. Still, there are things you can do to reduce flare-ups and your risk of developing this condition.

  • Avoid smoking, and if you do smoke, talk with a doctor about smoking cessation plans.
  • Use moisturizing creams and ointments on your palms and soles.
  • Replace your soap, bubble baths, and shower gels with moisturizing cleaning products for the skin.
  • Rest your feet and hands.
  • Keep your feet and hands clean.
  • Protect your hands with gloves while doing manual labor.
  • Wear cotton socks and shoes that fit comfortably. Avoid manufactured fibers that can irritate the skin.
  • Avoid injuries to the hands and feet.
  • Use salicylic acid or urea creams on the feet to reduce skin thickening and dead skin.

Read on for answers to more questions about palmoplantar pustulosis.

Does palmoplantar pustulosis go away?

Palmoplantar pustulosis is a chronic and debilitating condition that isn’t likely to go away. It can also be resistant to treatment.

Does stress cause pustular psoriasis?

Stress can be a trigger for pustular psoriasis. Specifically for palmoplantar pustulosis, research has found that about 90% of patients can experience flare-ups associated with stress.

Can you treat palmoplantar pustulosis naturally?

There are natural remedies that may be able to relieve symptoms in some psoriasis cases. These include things like aloe vera, apple cider vinegar, or turmeric. However, palmoplantar pustulosis is a type of pustular psoriasis that’s difficult to treat. You’re likely to need medications to manage the condition.

Palmoplantar pustulosis is a chronic condition. This rare autoimmune disease is more common among people who smoke and in females.

Although there’s no cure for palmoplantar pustulosis, treatments may help with the symptoms. You can also take steps to reduce your risk of getting it. The most important step is to consider quitting smoking or never starting.