Palmoplantar pustulosis is a clinically misdiagnosed dermatologic condition that is currently on the rise. Its manifestation refers to a chronic recurrent disease confined to the palmoplantar region, clinically characterized by periodic small sterile pustules on the basis of erythema, accompanied by keratinization and scaling. It occurs at the age of 50-60 years, and is more common in women than in men. Response to treatment is poor. Etiology The etiology of palmoplantar pustulosis is not clear. Some patients have a personal or family history of psoriasis or develop psoriasis vulgaris in the future. In some patients, the onset of the disease is associated with infections; patients with inflamed tonsils may have their lesions reduced or cured by antibiotic treatment or tonsillectomy. It may also be associated with metal sensitization, such as contact with metal-containing foods or metal dental materials. Smoking can also be a trigger. Clinical manifestations Palmoplantar pustulosis occurs in the 50-60 years of age and is more common in females than males, and is more common in the palmoplantar region than in the metacarpal region. Finger lesions are rare. Palmoplantar lesions are symmetrical. The basic damage is on the basis of erythema, the appearance of small and deep pustules, or first blisters and then become pustules. Recurrent episodes, sometimes mild and sometimes severe, with varying degrees of itching, the lesions may have a burning sensation, no systemic symptoms. Various external stimuli (soap, detergent and topical stimulating drugs, etc.), localized sweating in summer, premenstrual period, autonomic dysfunction and other factors can be triggered, worsening the symptoms. 1. Laboratory tests: Bacterial culture of pustular fluid is negative. 2. Histopathological examination: single-compartment pustules in the epidermis, a large number of neutrophils and a few monocytes in the pustules, mild hypertrophy of the surrounding epidermal stratum spinosum, and similar inflammatory cell infiltration in the dermis below the pustules. Immunopathologically, IgG, IgM, and IgA are found in the wall of the pustules, the stratum corneum, the basement membrane bands, and the walls of the blood vessels. Diagnosis The diagnosis is usually made on the basis of the occurrence of pustules on the palms and metatarsals of middle-aged women on the basis of erythema, with varying degrees of itching, and the pathologic changes of intra-epidermal pustules, which have a chronic course. Differential diagnosis Palmoplantar pustulosis should be differentiated from the following diseases: 1. Limited pustular psoriasis: Kogoj spongy pustules within the epidermis, surrounded by the pathological changes of psoriasis. 2. limited-type continuous acrodermatitis: pustules often initially appear on the ends of fingers and toes or around the nails, often accompanied by furrowed tongue, with Kogoj spongiform pustules within the epidermis. 3. Pustular bacterial rash: there is often an infected lesion, remove the lesion or use antibiotics after the pustules disappear and heal. Treatment 1.Systemic treatment Remove the causative agent, such as metal dental materials and mercury, silver fillings should do the metal patch test. Tetracycline; Vitamin A acid: such as Avitamin A, 8 weeks after the obvious improvement. Long-term application, the need for regular monitoring of adverse drug reactions; colchicine: pustules reduced, with maintenance doses; Lei Gongteng or Kunming Shan Hai Tang oral. 2. Local treatment Glucocorticoid sealing treatment is effective. It can be combined with topical tar or retinoid ointment. PUVA treatment or superficial X-ray irradiation is effective. 3. Traditional Chinese medicine treatment Chinese medicine to clear heat and remove toxins and dampness, can use white flower snake tongue grass, scutellaria, silver flower, dandelion, comfrey, red peony and so on.