Palmar-plantar pustulosis

September 7, 2022

Palmar-plantar pustulosis is a chronic skin disease characterized by rashes of sterile pustules on the palms and soles. The disease occurs at any age, even at an early age.

The prevalence increases approximately linearly over the course of life, from 0.12% at 1 year of age to 1.2% at 18 years of age [Wolf-Henning Bönke, Michael P. Schön].

In addition to the association with psoriasis, numerous studies have found associations with other pathological processes such as:

 autoimmune thyroid disease and the presence of thyroid antibodies; the presence of antigliadin antibodies, and a gluten-free diet improves the condition;

diabetes mellitus;

focal remote infection - when collecting anamnesis, it is often reported that patients have foci of chronic infection of bronchopulmonary pathology.

An association with other chronic recurrent diseases has also been noted.

Increased sensitivity, excessive response and emotional involvement in ongoing events, excessive emotional contact with the world, emotions associated with unreacted anger and anxiety often lead to an exacerbation or relapse of the disease [Raznatovsky K. I., 1997].

The disease is characterized by a rash of outlined erythematous plaques with numerous, isolated from each other, pustules 1-2-5 mm in size on the surface. Initially, vesicles appear, which quickly transform into yellow pustules, which, as the process progresses, become yellow-brown in color, and then shrink to form a dark brown crust. Pustules are usually observed at all stages of evolution. The plaques thicken over time with the appearance of lamellar peeling and painful cracks. The lesions are usually symmetrical. In the area of ​​​​the palms, the rash is localized in the central part, less often in the hypothenar region, the fingers are not always affected. In the foot area, the medial surface of the foot is usually affected, less often the lateral and back of the heel. In some patients, psoriasiform rashes are observed in the form of a few isolated plaques. Lesions may be limited or spread to the entire surface of the palms or soles with the capture of the side surfaces. The general condition is not violated. Patients are concerned about itching, burning, with the formation of cracks - pain, due to the purulent process, there may be subfibrile body temperature.

The course of the disease is chronic, relapsing. The process of exacerbation lasts for several weeks, then a temporary remission occurs.

Palmar-plantar pustulosis is a diagnosis of exclusion when clinical examination does not support a diagnosis of dermatitis or psoriasis. If the diagnosis is unclear, a cultural study is performed to exclude fungal and bacterial infections and a histological examination.

Given the immune-mediated nature of the disease, which can affect the skin, joints, or both, it often requires the help of different specialists with a wide range of knowledge to treat it. Psoriasis causes many problems, including:

high prevalence,

chronic course,

disability and

comorbidity.

 Understanding the role of immune function in the pathogenesis of the disease, as well as the interaction between the innate and adaptive immune systems, helps to manage this complex disease that affects patients far beyond the skin.

Treatment Methods

Autoimmune inflammation requires individually selected complex therapy, lifestyle changes, nutrition, elimination of all bad habits. Modern medicine has proposed three basic principles for the successful treatment of psoriasis:

strict adherence to the algorithms for the prescribed therapy;

regular monitoring of the effectiveness of therapy;

timely correction of the prescribed therapy in case of its insufficient effectiveness.

 Nutrition for psoriasis

There is no special diet for psoriasis, but nutrition is of great importance. Therefore, when prescribing complex treatment, recommendations on nutrition are necessarily given:

identify hypersensitivity of the body to certain products and exclude them from the diet;

give preference to fresh vegetables, non-acidic fruits and berries, boiled and baked lean meat, drink more;

Aynur Taubaeva,

dermatovenereologist for children and adults, head of the inpatient department of KNTsDIZ

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