Skin Diseases

Skin Diseases

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Palmoplantar pustulosis

Palmoplantar pustulosis is a chronic pustular condition affecting the palms and soles.

The exact cause of palmoplantar pustulosis is unknown. It appears to be a disorder of the eccrine sweat glands, which are most numerous on palms and soles.

Palmoplantar pustulosis is probably autoimmune in origin ('self allergy'), as there is an association with other autoimmune diseases particularly gluten sensitive enteropathy (celiac disease), thyroid disease and type 2 diabetes.

Palmoplantar pustulosis was previously considered to be a localised form of pustular psoriasis but about 10-20% of patients with palmoplantar pustulosis have psoriasis elsewhere. It is now known that they are distinct conditions with different genetic backgrounds.

Genetic factors account for family members having the disease. However, it rarely occurs before adulthood. It is more common in women than men.

Palmoplantar pustulosis is much more common in current smokers (and in those that have smoked in the past). It is thought that activated nicotine receptors in the sweat glands cause an inflammatory process.

Dermatitis, particularly pompholyx, and tinea pedis (a fungus infection) may appear similar, but require different treatment.

Clinical features

Palmoplantar pustulosis presents as crops of sterile pustules occurring on one or both hands and/or feet. They are associated with thickened, scaly, red skin which easily develops painful cracks (fissures).

The condition varies in severity and may persist for many years. It is not known what causes exacerbations or remissions. Palmoplantar pustulosis is not infectious to other people and does not influence one's general health. However the discomfort can be considerable, interfering with working and leisure activities.

Walking for prolonged periods may cause exacerbations on the feet. If the palms are involved, manual activities may be uncomfortable, and injuries may aggravate the disorder. Certain occupations are therefore inadvisable for affected individuals.

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