Palmar-plantar pustulosis is a clinically easily misdiagnosed dermatological condition that is currently on the rise. Its manifestation refers to a chronic recurrent disease confined to the palmoplantar region, characterized by the periodic appearance of small sterile pustules on top of erythema with keratinization and scaling. It is more common in women than in men, and occurs between 50 and 60 years of age. Response to treatment is relatively poor.
Etiology of palmoplantar pustulosis
The etiology of palmoplantar pustulosis is unclear. Some patients have a personal or family history of psoriasis, or develop psoriasis vulgaris in the future. In some patients, the onset is associated with infection, and lesions may be reduced or cured after antibiotic treatment or tonsillectomy in patients with inflammation of the tonsils. Or it may be associated with metal allergies, such as exposure to metal-containing foods or metal dental materials, and smoking can also be a trigger.
Clinical manifestations of palmoplantar pustulosis
Palmoplantar pustulosis occurs in 50-60 years of age, more common in women than men, with the prevalent sites in the palmoplantar, and more common in the metatarsal than the palm. Finger lesions are rare. The palmoplantar lesions are symmetrical. The basic damage is the appearance of small, deep pustules on top of erythema, or first blisters and then pustules. The lesions are recurrent, sometimes mild and sometimes severe, with varying degrees of pruritus and a burning sensation at the lesions, without systemic symptoms. Various external stimuli (soaps, detergents and topical irritants, etc.), local sweating in summer, PMS, autonomic dysfunction and other factors can trigger and worsen the symptoms.
Examination of palmoplantar pustulosis
1.Laboratory examination
Bacterial culture of pustular fluid is negative.
2.Histopathological examination
Single-roomed pustules in the epidermis, with a large number of neutrophils and a few mononuclear cells in the pustules, mild epidermal hypertrophy of the surrounding epidermis, and infiltration of inflammatory-like cells in the dermis below the pustules. Immunopathology revealed IgG, IgM, IgA, and C3 deposits in the pustule wall, stratum corneum, basement membrane zone, and vascular wall.
Diagnosis of palmoplantar pustulosis
The diagnosis is usually made on the basis of the occurrence of pustules on the palmoplantar area of middle-aged women on the basis of erythema with varying degrees of itching, pathological changes of intraepidermal pustules, and a chronic course.
Differential diagnosis
Palmoplantar pustulosis should be differentiated from the following diseases.
1. confined pustular psoriasis: intraepidermal Kogoj sponge-like pustules surrounded by pathological changes of psoriasis.
2. limited-type continuous acrodermatitis: pustules often first appear at the ends of fingers and toes or around the nails, often with furrowed tongue and Kogoj sponge-like pustules within the epidermis.
3, pustular bacterial rash: there are often foci of infection, and the pustules disappear and heal after removing the foci or using antibiotics.
Treatment of palmoplantar pustulosis
1.Systemic treatment
Removal of causative factors, such as those equipped with metal teeth and with mercury and silver fillings should do metal plaque test. Tetracycline; retinoic acid: such as Avelox, which improves significantly after 8 weeks. Long-term application, need to regularly monitor the adverse drug reactions; colchicine: after the reduction of pustules, with maintenance dose; Reglan or Kunming Shanghang orally.
2.Local treatment
Glucocorticoid encapsulation therapy is effective. It can be combined with topical tar-like or retinoic acid ointment. PUVA treatment or superficial X-ray irradiation is effective.
3.Chinese medicine treatment
Chinese medicine is based on clearing heat and detoxifying dampness, which can be treated with Baiflora serratifolia, Scutellaria baicalensis, Yinhua, Dandelion, Comfrey, Red peony, etc.