Palmoplantar Pustulosis vs. Palmoplantar Psoriasis

Psoriasis is a complex condition with several subtypes that often cause confusion. Two conditions that frequently get mistaken for one another are Palmoplantar Pustulosis (PPP) and Palmoplantar Psoriasis (PPPso). While both affect the hands and feet, they have distinct symptoms, triggers, and treatment approaches. Understanding these differences is essential for proper diagnosis and effective management.

What is Palmoplantar Pustulosis (PPP)?

Palmoplantar Pustulosis is a rare, chronic skin condition that primarily affects the palms of the hands and soles of the feet. It is characterized by pus-filled blisters (pustules) that appear on reddened, inflamed skin. The pustules eventually dry out, turning into scaly, brown patches before new flare-ups begin.

Symptoms of Palmoplantar Pustulosis:

• Clusters of pus-filled blisters that appear cyclically

• Painful, inflamed skin that may become cracked

• Scaling and peeling of affected areas

• Flare-ups triggered by stress, smoking, or infections

What is Palmoplantar Psoriasis (PPPso)?

Palmoplantar Psoriasis is a chronic form of plaque psoriasis that affects the palms and soles but without pustules. Instead, it presents as thickened, scaly, red patches that can be painful and lead to cracking and bleeding.

Symptoms of Palmoplantar Psoriasis:

• Thick, scaly plaques on the hands and feet

• Cracking and painful fissures

• Redness and inflammation

• Persistent, chronic symptoms rather than cyclical flares

Key Differences Between Palmoplantar Pustulosis and Palmoplantar Psoriasis

What Causes These Conditions?

Both conditions are autoimmune disorders, meaning the immune system mistakenly attacks healthy skin cells, causing inflammation and excessive skin turnover. However, they have distinct triggers:

• Palmoplantar Pustulosis Triggers: Smoking, bacterial infections, stress, withdrawal from corticosteroids.

• Palmoplantar Psoriasis Triggers: Friction, repetitive trauma, genetic predisposition, smoking.

Best Treatments for Each Condition

Treatments for Palmoplantar Pustulosis (PPP):

• Topical Corticosteroids – Help reduce inflammation but should be used with caution.

• Coal Tar and Salicylic Acid Preparations – Aid in exfoliating and soothing the skin.

• Biologics (For Severe Cases) – TNF inhibitors and IL-17 blockers like secukinumab or adalimumab.

• Narrowband UVB Phototherapy – Can help slow skin turnover and reduce symptoms.

Treatments for Palmoplantar Psoriasis (PPPso):

• Topical Treatments – Corticosteroids, vitamin D analogs, and retinoids.

• Nopsor Topical Treatment – A steroid-free alternative containing coal tar, salicylic acid, and a proprietary herbal mix to relieve inflammation and promote healing.

• Phototherapy – Light therapy can help slow excessive skin cell turnover.

• Moisturization – Keeping the skin well-hydrated prevents cracking and discomfort.

When to See a Dermatologist

Since both conditions can be difficult to distinguish, it's important to consult a dermatologist for an accurate diagnosis. Work closely with them to develop a treatment plan and provide feedback on how your skin is responding to treatments. If symptoms worsen or cause severe pain, additional medical intervention may be needed.

Final Thoughts

While Palmoplantar Pustulosis and Palmoplantar Psoriasis share some similarities, they are distinct conditions that require tailored treatments. Understanding these differences can lead to better management and improved quality of life.

Further Reading:

• Best Treatments for Palmoplantar Psoriasis
• Psoriasis Triggers: Foods You Should Avoid for Clearer Skin
• Natural Remedies for Palmoplantar Psoriasis

References

• Palmoplantar Psoriasis - StatPearls - NCBI Bookshelf: This resource provides an in-depth overview of palmoplantar psoriasis, including its etiology, epidemiology, pathophysiology, and clinical features.

  ncbi.nlm.nih.gov

   

• Psoriasis of the Palms and Soles - DermNet NZ: DermNet NZ offers detailed information on the clinical presentation, associated features, and management of psoriasis affecting the palms and soles.

  dermnetnz.org

   

• Palmoplantar Pustulosis - DermNet NZ: This article discusses the characteristics, associated conditions, potential causes, and treatment options for palmoplantar pustulosis.

  dermnetnz.org

   

• Psoriasis: Symptoms and Causes - Mayo Clinic: The Mayo Clinic provides a comprehensive guide on psoriasis, covering its symptoms, causes, risk factors, and complications.

  mayoclinic.org

   

• Palmoplantar Pustulosis: Recent Advances in Etiopathogenesis and Treatment: This publication reviews recent studies on the genetic differences, immunological factors, and microbiome involvement in the pathogenesis of palmoplantar pustulosis, as well as emerging treatment options.

  pmc.ncbi.nlm.nih.gov