Palmoplantar pustular disease

The cause of palmoplantar pustular disease is still not very clear. Many patients cannot find any cause after being diagnosed with the disease. They can only make judgments based on their medical history and clinical symptoms. This will result in patients being unable to take timely symptomatic treatment, and their symptoms will become more and more severe. In addition, the disease will recur repeatedly and cannot be cured by any treatment methods.

The cause of palmoplantar pustulosis is unknown. Some patients have a personal or family history of psoriasis, or may develop psoriasis vulgaris in the future. The disease is related to infection in some patients. The skin lesions of patients with tonsillitis can be alleviated or cured after antibiotic treatment or tonsillectomy. Or it may be related to metal allergy, such as contact with metal-containing foods or metal tooth materials. Smoking can also be a trigger.

Palmoplantar pustulosis is common in people aged 50-60 years old, more common in women than in men, and more common in the palms and soles, with the plantars being more common than the palms. Lesions on the fingers are uncommon. The palmoplantar lesions are symmetrical. The basic lesion is the appearance of small and deep pustules on the basis of erythema, or blisters first and then pustules.

The disease recurs repeatedly, sometimes mild and sometimes severe, with varying degrees of itching and a burning sensation at the lesions, but no systemic symptoms. Various external stimuli (soap, detergents and external irritant drugs, etc.), local hyperhidrosis in summer, premenstrual period, autonomic nervous dysfunction and other factors can induce and worsen the symptoms.

1. Laboratory examination

Bacterial culture of pustular fluid was negative.

2. Histopathological examination

There are single-chamber pustules in the epidermis, with a large number of neutrophils and a few monocytes in the pustules. The surrounding epidermis has mild acanthosis, and there is similar inflammatory cell infiltration in the dermis below the pustules. Immunopathology showed deposition of IgG, IgM, IgA and C3 in the pustular wall, stratum corneum, basement membrane zone and blood vessel wall.

Palmoplantar pustulosis should be differentiated from the following diseases:

1. Localized pustular psoriasis: There are Kogoj sponge-like pustules in the epidermis, surrounded by psoriasis pathological changes.

2. Localized continuous acrodermatitis: Pustules often first appear at the ends of fingers and toes or around the nails, often accompanied by grooved tongue and Kogoj sponge-like pustules in the epidermis.

3. Pustular bacterial rash: There are often infection foci, and the pustules disappear and heal after removing the lesions or using antibiotics.