By Gary M. White, MD
Palmoplantar pustulosis (PPP) is a chronic pustular dermatosis of the palms and soles. An arthrosteitis has been associated and may be manifested by painful episodes of the anterior chest wall, and less commonly the knee, spine and ankle. Smoking is strongly associated.
Deep-seated pustules on the palms or soles which don't rupture but instead turn brown is characteristic. The course is chronic. Clinical examination should exclude the SAPHO syndrome which has this as a major skin manifestation.
Potent topical steroid ointments are the mainstay of therapy for mild disease. They may be occluded for added benefit. Smokers should quit. Ustekinumab controlled 5 patient's disease quite effectively. Etanercept has been used successfully. Acitretin can be very effective for long-term control of significant disease. Other treatments that have been used include PUVA (oral or topical), PUVA plus acitretin, dapsone, methotrexate, clofazimine, and colchicine. Refractory PPP responds very well to cyclosporin 2.5 mg/kg/d for 3 months, then tapered. Unfortunately, generalized pustular psoriasis has developed in patients following withdrawal of CSA for treatment of PPP.
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