Pustular Psoriasis of Hands and Feet

Key Points
Subtype of Palmoplantar psoriasis which typically affects the palms of the hands and/or soles of the feet
Cause of psoriasis is unknown, but is thought to be due to functional errors in the immune system
Consists of the formation of small yellow to brown pustules which appear in sheets

Palmoplantar pustulosis is a subtype of palmoplantar psoriasis which typically affects the palms of the hands and/or the soles of the feet. The condition presents as small, yellow to brown pustules which form in sheets. Additionally, it may be accompanied by redness, scaling, dryness and cracking of the affected area, which causes pain and limits movement. The condition is typically chronic and recurrent.

The exact cause of psoriasis is unknown, but the condition seems to arise from functional errors in the immune system. Palmoplantar pustulosis tends to be more common in persons who smoke or have smoked, but may also be hereditary. The condition typically presents in adulthood.

Differential Diagnosis (Other conditions with similar appearance)
Pityriasis rubra pilaris
Secondary Syphilis
Dyshidrotic Eczema
Tinea pedis

Diagnosis
Key Points
Diagnosis based on skin appearance
Skin biopsy may be performed to confirm diagnosis and to rule out other conditions

Palmoplantar pustulosis is typically diagnosed based on the appearance of the affected area. A skin biopsy may be performed to confirm the diagnosis and to rule out other, similar appearing conditions.

Treatment
Avoiding trauma or repetitive friction is advised
In mild cases, topical therapies are typically used
Severe cases may require more aggressive therapies

Avoiding trauma, repetitive friction, and other stimuli which may worsen the condition is advised. In milder cases, topical therapies such as use of emollient creams, coal tar preparations, creams containing urea or salicylic acid, and topical steroids are typically used to treat the condition. Severe cases may require more aggressive therapies, such as phototherapy and systemic treatments such as acitretin and methotrexate.