Psoriasis: palmoplantar pustulosis

LAST UPDATED: Nov 18, 2021

Introduction

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

This chapter is set out as follows:

Aetiology
Clinical findings
Images
Management

Aetiology

Age - mainly presents in patients over 50 years
Females more than males
Strong link with cigarette smoking, although unfortunately stopping smoking does not often lead to an improvement
Approximately 25% of patients have a background of chronic plaque psoriasis

Clinical findings

Distribution

Palms, soles (especially heel and instep) or both

Morphology

Erythema
Yellow pustules (active), which then become brown macules

Clinical Images

Please refer to notes on image rights at bottom of the page with regards to individual image ownership.

Palmoplantar pustulosis

Yellow pustules…

Management

Provide a patient information leaflet

Effective treatment can be difficult:

Potent topical steroids such as 0.1% Betnovate ® or Dermovate ® ointment used at night under occlusion (eg Clingfilm)

Patients failing to respond should be referred to dermatology out-patients for consideration of hand / foot phototherapy or systemic therapy

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Image Rights - The PCDS would like to thank Dermatoweb, DermQuest (Galderma), and others who have contributed images. All named individuals and organisations maintain copyright for the relevant images.