Palmoplantar pustular psoriasis is a rare skin condition that affects the soles of your feet and sometimes, the palms of your hands. The right diagnosis and treatment may help ease your symptoms.

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Psoriasis is a fairly common skin condition that causes patches of scaly, inflamed skin. It affects about 2%–3% of the global population.

Pustular psoriasis is a specific type of psoriasis that’s relatively rare. Only about 1% of all people diagnosed with psoriasis have pustular psoriasis. You can have this condition along with another type of psoriasis, such as plaque psoriasis.

This condition causes you to develop painful, pus-filled blisters called pustules. If these pustules show up on the soles of your feet or the palms of your hands, you have what’s called palmoplantar pustular psoriasis.

Like other forms of psoriasis, this condition isn’t contagious.

Here’s what to know about identifying and treating pustular psoriasis on your feet.

Your symptoms may start with your skin becoming discolored and tender. After a few hours, bumps filled with yellowish or white pus start to form on the soles of your feet and sometimes, the palms of your hands.

Often, you’ll notice inflamed, irritated skin around these pustules.

The pustules may have different colors, depending on your skin tone.

If you have:

  • Lighter skin: They may appear pink or red.
  • Medium skin: They may appear dark pink.
  • Darker skin: They may appear purplish, gray, or brown.

The bumps themselves may feel painful or cause a burning sensation. They tend to appear in small groups and cluster together. Within a day or two, they’ll burst and release pus, which eventually crusts over. When they peel off, your skin may appear scaly or shiny, and new pustules may begin to form.

Although the exact cause remains unknown, your immune system may play a role in the development of pustular psoriasis.

Experts considered psoriasis an autoimmune disease because the body seems to attack healthy tissue by mistake, causing inflammation and pustules.

A number of risk factors may increase your chances of developing palmoplantar pustular psoriasis, including:

  • Smoking: Cigarette smoking is a known psoriasis trigger. Smoking can cause inflammation in your sweat glands, which can lead to the development of pustules.
  • Infections: Bacterial infections like tonsillitis, sinusitis, and strep throat may trigger this condition.
  • Certain medications: Some medications, such as lithium, penicillin, and systemic steroids, may trigger this condition. Your symptoms might also begin if you suddenly stop taking corticosteroids, such as prednisone.
  • Family history: If your close relatives have psoriasis, you have a higher chance of developing the condition yourself.
  • Autoimmune disease: Having another autoimmune disease can increase your risk of developing psoriasis.
  • Pregnancy: For some people, pregnancy triggers a first psoriasis flare.
  • Stress: Emotional stress may trigger outbreaks.
  • Certain vaccinations: Some people have a first flare after receiving the BCG tuberculosis vaccine or the H1N1 vaccine.
  • Weather changes: Skin dryness and irritation from dry, cold, or windy weather can trigger psoriasis flares, as can exposure to UV light.

It’s not uncommon to mistake palmoplantar pustular psoriasis for athlete’s foot or another skin condition. If you have a rash on the soles of your feet, a good next step involves making an appointment with a doctor or other healthcare professional.

Your doctor can refer you to a dermatologist who can make a thorough diagnosis and help you develop a treatment plan.

To diagnose pustular psoriasis, a dermatologist may:

  • Do a complete blood count to check for symptoms of inflammation or white blood cell abnormalities. If you have pustular psoriasis, your blood test might show a reduced number of lymphocytes, a type of white blood cell.
  • Collect a skin swab to make sure there are no bacteria or fungi inside the pustules.
  • Recommend a skin biopsy, which involves taking a piece of skin from the affected area to test it for signs of psoriasis.

It’s especially important to get treatment right away if you notice blisters or have trouble walking or wearing shoes.

Experts have yet to find a cure for psoriasis.

Palmoplantar pustular psoriasis can be challenging to treat due to its location, but support from a dermatologist can make a major difference in your symptoms.

Several treatments can help reduce symptoms and flare-ups. Some of the most effective methods include:

  • Ointments: Ointments usually offer a first mode of defense against psoriasis. These might include emollients, steroids, vitamin D analogs, coal tar, or calcineurin inhibitors. These topical treatments can soothe your skin and curb inflammation.
  • UV light therapy: UV light (both natural and artificial) can help treat all types of psoriasis. Your dermatologist may also recommend PUVA therapy. This approach combines UV light and psoralen, an oral medication that makes your skin more sensitive to UV rays.
  • Medication: Your doctor may also recommend medications to help treat your symptoms and minimize flares. Examples include the oral retinoid acitretin (Soriatane), cyclosporine (Gengraf, Neoral, Sandimmune), or methotrexate (Otrexup, Rasuvo). They may also recommend biologics, or medications made from living organisms such as bacteria, human cells, and animal cells.

It may take some trial and error with your dermatologist until you find the treatment regimen that works best for you. For some people, a combination of treatments leads to the most improvement.

Using natural remedies alongside traditional treatments can be an effective way to soothe symptoms and improve your quality of life.

Some ways to address pustular psoriasis at home include:

  • using aloe vera gel or cream to reduce inflammation
  • trying acupuncture to ease pain (Evidence supporting acupuncture as a remedy for psoriasis remains inconsistent, but many people find it helpful.)
  • applying capsaicin cream or ointment to ease pain (Capsaicin, the active component in chili peppers, works by blocking nerve endings and may also help reduce swelling and inflammation.)
  • soaking your feet in an Epsom salt bath to soothe itchiness, pain, and inflammation
  • taking turmeric (Curcumin, the active compound in this golden spice, contains anti-inflammatory properties that can help reduce psoriasis flare-ups.)

A few other lifestyle changes that may help reduce psoriasis flares include:

Pustular psoriasis of the feet — also called palmoplantar pustular psoriasis — is a rare type of psoriasis that causes painful pustules. There’s no cure for this condition, but a dermatologist can help you find the most helpful treatment for your symptoms.

Common treatments include UV light therapy, prescription medication, and topical medications. These approaches, along with natural remedies like aloe vera gel and Epsom salt baths, can help relieve symptoms and improve your quality of life.

Your dermatologist may also recommend keeping your skin hydrated and avoiding triggers to help reduce flare-ups.