Palmoplantar pustular psoriasis, sometimes called palmoplantar pustulosis, is a rare type of painful psoriasis that develops on the palms of your hands and the soles of your feet.

Psoriasis is a group of chronic autoimmune skin conditions that cause inflammation. Pustular psoriasis causes pus-filled bumps and other symptoms like:

  • redness
  • itchiness
  • painful skin

Palmoplantar pustular psoriasis, sometimes also called palmoplantar pustulosis, is a type of pustular psoriasis that develops on the palms of your hands and the soles of your feet. It’s estimated to affect 1 in 2,000 to 1 in 10,000 people in Western Europe and North America.

Read on to learn more about this rare type of psoriasis including symptoms, causes, and treatment options.

Palmoplantar pustular psoriasis causes reoccurring flare-ups of pus-filled bumps on the palms of your hands and the soles of your feet. It affects both sides of your body, but one side might have more symptoms.

Bumps are usually filled with yellow or white fluid and can turn darker when they dry out. The exact color depends on your skin tone. They can range from 1 to 10 millimeters across.

It’s also common to experience:

Pain may be severe enough to make walking or performing other daily activities difficult.

After a few days, you may develop areas of thick skin and scaly patches that resemble the most common form of psoriasis, called plaque psoriasis.

Researchers don’t know exactly why some people develop palmoplantar psoriasis. It’s thought that some gene mutations inherited through families make some people susceptible to palmoplantar psoriasis if they encounter environmental triggers.

The most common gene linked to palmoplantar psoriasis is a variation of the HLA gene called HLA-Cw6. HLA is one of the most variable genes in humans. Palmoplantar pustulosis may also be linked to certain mutations in the CARD14 gene and some IL-19 genes.

Symptoms occur when your immune system attacks healthy cells in your skin. Potential triggers for palmoplantar pustulosis include:

  • smoking
  • stress
  • infections
  • medications including TNF-alpha inhibitors used to treat psoriasis
  • contact allergies
  • family history
  • friction
  • physical trauma

It’s thought that triggers activate immune cells called dendritic cells and T-cells, which leads to the accumulation of molecules that create inflammation.

Is palmoplantar pustular psoriasis contagious?

Palmoplantar pustular psoriasis and other types of psoriasis are not contagious. They’re not caused by infections and can’t be passed to other people.

Women who smoke are at the highest risk of developing palmoplantar pustulosis.

More than 80% of people with palmoplantar pustulosis are women. It most often appears between the ages of 40 to 58.

It has been suggested that smoking might activate nicotine receptors in the sweat glands in your palms and soles, which may set off the inflammatory reactions that lead to palmoplantar pustular psoriasis symptoms.

Palmoplantar pustulosis has also been linked to thyroid disease and arthritis of the front of the chest.

Here are some examples of what palmoplantar pustular psoriasis looks like:

Palmoplantar pustular psoriasis is a long-lasting condition that can cause flare-ups over your lifetime.

Though spontaneous remission can occur, the persistence of flares is common. People may experience exacerbations brought on by:

  • seasonal changes
  • household work
  • cleaning detergents

No standard therapy for palmoplantar pustular psoriasis has been developed. For more severe disease, a doctor may recommend topical medications, oral medications, or light therapy.

Medical treatment

The first-line therapy for palmoplantar pustular psoriasis is often topical corticosteroids. These medications help reduce inflammation in the areas they’re applied to.

If these aren’t effective by themselves, a doctor may recommend:

  • Phototherapy: Phototherapy involves exposing your skin to particular wavelengths of ultraviolet light to reduce inflammation. Most studies have found that one type called photochemotherapy to be moderately effective at treating palmoplantar pustular psoriasis.
  • Oral retinoids: Oral retinoids like acitretin may help reduce swelling and other psoriasis symptoms. They’re often combined with light therapy.
  • Immunosuppressants: In severe cases, a doctor may recommend oral medications like methotrexate or cyclosporine to reduce the activity of your immune system.

A doctor may recommend biologics, which block inflammatory reaction, such as:

The medication spesolumab was FDA approved to treat generalized pustular psoriasis in September 2022. Research is underway examining whether it’s an effective treatment for palmoplantar pustular psoriasis.

Home remedies and natural treatment

The following may also be helpful for managing your symptoms:

  • Moisturizers: Moisturizing your skin with an emollient can potentially help prevent cracking of your skin when fluid-filled bumps heal over.
  • Salicylic acid: Creams with salicylic acid may help treat scaling skin and swelling.
  • Wearing gloves: Wearing cotton gloves throughout the day may help prevent creams from rubbing off and minimize discomfort when using your hands.
  • Avoid harsh soaps: Harsh soaps may dry out your skin and make your symptoms worse. Soaps that contain fragrances are often the harshest on your skin. Using mild soaps is recommended.
  • Quitting smoking: If you smoke, quitting smoking may help reduce flare-ups and symptom severity, but more research is needed to understand how quitting affects psoriasis. Quitting is often difficult, but a doctor can create a cessation plan that works for you.

It’s a good idea to visit a doctor if you think you may have psoriasis but haven’t already received a diagnosis. A doctor can rule out other conditions and help you build a treatment plan.

A primary care doctor will likely refer you to a skin specialist called a dermatologist if there’s any question about your diagnosis or if topical treatments aren’t effective.

It’s generally recommended that people with any type of pustular psoriasis should see a dermatologist every 3 months or as needed to manage symptoms.

Doctors can usually diagnose palmoplantar pustular psoriasis by examining your skin, evaluating your symptoms, and reviewing your medical and family history. They may want to take a biopsy to rule out other conditions like bacterial or fungal infections. A biopsy involves taking a small skin sample for laboratory analysis.

One condition that causes similar symptoms to palmoplantar pustular psoriasis is called pompholyx, or dyshidrotic eczema. It’s rarely difficult for doctors to have trouble telling them apart.

Smoking is one of the top risk factors for palmoplantar pustular psoriasis. Avoiding smoking or quitting if you already smoke may help minimize your odds of developing palmoplantar pustular psoriasis.

You can try to lessen palmoplantar pustulosis flare-ups by reducing your exposure to your triggers. You may be able to find your triggers by tracking when your flare-ups occur along with other factors like your:

  • medications
  • diet
  • stress levels

Over time, you may notice patterns in when your symptoms occur.

Palmoplantar pustular psoriasis, sometimes also called palmoplanter pustulosis, is a subtype of psoriasis that causes fluid-filled bumps to form on the soles of your feet and the palms of your hands. Researchers aren’t entirely sure why it develops, but it’s thought to occur when your immune cells attack healthy skin cells.

No medications have been approved specifically for treating palmoplantar psoriasis, but some are in development. Topical corticosteroids are often the first treatment doctors recommend.

Smoking is one of the top risk factors for palmoplantar pustular psoriasis. Quitting smoking, if you smoke, may help you minimize the severity or frequency of your flare-ups.