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Palmoplantar pustulosis in Child
Other Resources UpToDate PubMed

Palmoplantar pustulosis in Child

Contributors: Rajini Murthy MD, Susan Burgin MD
Other Resources UpToDate PubMed


Palmoplantar pustulosis is a chronic eruption of the palms and soles composed of sterile vesicles and pustules. It is symmetric in distribution, often accompanied by painful fissuring, and is most commonly seen in women aged 40-60. It may resolve spontaneously; however, periods of exacerbation and remission may occur. Systemic symptoms are usually absent.

Known risk factors for the development of palmoplantar pustulosis include stress and smoking. Other associated diseases include psoriasis vulgaris, arthritis (psoriatic arthritis with prevalence of 10%-25%), SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis), thyroid dysfunction (prevalence of 20%-40% and more commonly seen in women), and metabolic syndrome.

Palmoplantar pustulosis may occur alongside or follow a systemic infection. Poststreptococcal pustulosis occurring in the setting of group A streptococcal infection has been reported, responding to high-potency topical steroids along with treatment of the underlying infection. Other postinfectious etiologies that have been reported include odontogenic infections, upper respiratory infections, and Helicobacter pylori infections. Tumor necrosis factor (TNF)-alpha inhibitors, notably, have been implicated in the development of palmoplantar pustular lesions when used to treat psoriasis or inflammatory bowel disease. Only a minority of these patients demonstrate classic plaque psoriasis elsewhere. Metal allergy has also been associated with palmoplantar pustulosis.


L40.3 – Pustulosis palmaris et plantaris

27520001 – Pustular psoriasis of palms and soles

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Pustular psoriasis – Widespread distribution, not restricted to palms and soles; acute eruption of sterile pustules resolving within days.
  • Dyshidrotic dermatitis – Deep-seated vesicles of the palms, intensely pruritic. There may be cloudy vesicles as well.
  • Tinea pedis or Tinea manus – Pruritic, erythematous, and scaly; often unilateral or asymmetric; verify with potassium hydroxide (KOH) test.
  • Infected Atopic dermatitis – Perform culture when in doubt; atopic dermatitis will not be restricted to palms and soles; patient usually carries history of the diagnosis.
  • Scabies – Look for burrows in the web spaces of the fingers; intensely pruritic; not restricted to palms and soles.
  • Allergic contact dermatitis
  • Reactive arthritis
  • Epidermolysis bullosa simplex
  • Herpes simplex virus

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:10/19/2020
Last Updated:11/18/2020
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Palmoplantar pustulosis in Child
A medical illustration showing key findings of Palmoplantar pustulosis : Erythema, Painful skin lesions, Palms and soles
Clinical image of Palmoplantar pustulosis - imageId=155213. Click to open in gallery.  caption: 'Several large pustules, some brown incipient crusts, and superficial scale on the heel.'
Several large pustules, some brown incipient crusts, and superficial scale on the heel.
Copyright © 2024 VisualDx®. All rights reserved.