What is palmoplantar pustulosis?

Palmoplantar pustulosis is a chronic skin condition. Blisters and fluid-filled bumps known as pustules appear on the palms of the hands and the soles of the feet. It’s a rare autoimmune condition, and it’s more likely to affect people who currently or used to smoke.

Palmoplantar pustulosis 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.

Palmoplantar pustulosis is more common in adults than in children. 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 (fluid-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.

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

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

Palmoplantar pustulosis and psoriasis

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

According to a paper published in 2017, palmoplantar pustulosis is more common in women than men. It’s more likely to occur in older adults, and it’s rare in children.

The most common risk factors include:

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

The diagnosis process for palmoplantar pustulosis starts by looking at your skin. Your doctor will examine the skin on your palms and soles to check for blisters or pustules. They may need to do several tests to rule out other medical problems.

These tests include:

  • physical exam and medical history
  • skin biopsy
  • swab or scrape of the skin to check for infections
  • laboratory tests to check for infections

Learn more: Will a skin biopsy confirm I have 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 of time.

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, your doctor may recommend other treatments, including:

  • immunosuppressive therapy
  • cyclosporine (Sandimmune)
  • methotrexate

Palmoplantar pustulosis can be resistant to treatment. It may take time 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:

  • difficulty walking or doing daily tasks
  • pain that affects activities and 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 to your doctor about smoking cessation plans.
  • Use moisturizing creams and ointments on your palms and soles.
  • Replace 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 proper shoes. Avoid manmade 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.

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

Although there is 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 stop smoking or never start.