Palmoplantar pustulosis in Adult
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
- Pustular psoriasis – Widespread distribution, not restricted to palms and soles; acute eruption of sterile pustules resolving within days.
- Dyshidrotic eczema – Deep-seated vesicles of the palms, intensely pruritic. There may be cloudy vesicles as well.
- Tinea pedis or 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 infection