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Palmoplantar pustulosis in Adult
Other Resources UpToDate PubMed

Palmoplantar pustulosis in Adult

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

Synopsis

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.

Codes

ICD10CM:
L40.3 – Pustulosis palmaris et plantaris

SNOMEDCT:
27520001 – Pustular psoriasis of palms and soles

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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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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References

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Last Reviewed:10/20/2020
Last Updated:11/19/2020
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Palmoplantar pustulosis in Adult
Palmoplantar pustulosis : Erythema, Painful skin lesions, Palms and soles, Pustules
Clinical image of Palmoplantar pustulosis
Several large pustules, some brown incipient crusts, and superficial scale on the heel.
Copyright © 2021 VisualDx®. All rights reserved.