Updated: 2/15/2019

Pustulosis Palmoplantaris

Topic
Review Topic
0
0
https://upload.orthobullets.com/topic/4037/images/palmarplantar_pustulosis9_rd.jpg
Introduction
  • Crops of sterile pustules that occur on one or both hands and feet, also known as pustular psoriasis
  • Introduction
    • demographics
      • more common in middle-aged men than in women
      • rare in children
    • risk factors
      • the majority of patients are smokers (65–90%)
      • increased stress
      • infection (i.e acute or chronic tonsillitis)
      • drugs (i.e.TNF-alpha inhibitors)
  • Pathophysiology
    • unknown
      • therories
        • activated nicotine receptors in the sweat glands cause an inflammatory process
  • Associated conditions
    • orthopaedic conditions
      • chronic recurrent multifocal osteomyelitis
      • synovitis–acne–pustulosis–hyperostosis–osteomyelitis (SAPHO) syndrome
        • rare presentations of arthropathy
    • medical conditions & comorbidities
      • autoimmune diseases 
        • gluten sensitive enteropathy (celiac disease) 
        • thyroid disease 
        • type 1 diabetes
  • Prognosis
    • not contagious
    • varies in severity and can persist for many years
    • little effect on general health
Presentation
  • Symptoms
    • pruritis, bruning sensation and occasionally pain
    • worsend by pressure, rubbing and friction
    • may have discomfort walking 
    • significant psychologic effect
  • Physical exam
    • inspection
      • 1 to 10 mm sterile pustules on palms +/- soles of feet
      • surrounding erythema and fissures
      • usually bilateral
    • motion
      • joint pain suggestive of SAPHO
Studies
  • Labs
    • no serological tests are specific for disease
    • laboratory tests for bacterial infection are negative
  • Biopsy and diagnositc injections
    • skin biopsy may be helpful but is rarely necessary
Treatment
  • Non-operative 
    • general measures
      • smoking cessation
      • skin moiturization
      • avoidance of irrtants
    • topical corticosteroids, oral retinoid, photochemotherapy
      • indications
        • first-line therapy
      • outcomes
        • low-risk for adverse effects with topical corticosteriod therapy

 

 

Please rate topic.

Average 4.0 of 5 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (1)
Private Note