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Palmoplantar Pustulosis and Allergies: A Systematic Review
Alexandra M G Brunasso Vernetti1, Matteo Puntoni2, Cesare Massone1
1Department of Dermatology, Galliera Hospital, Genoa, Italy.
Background:
In 2007 the International Psoriasis Council considered palmoplantar pustulosis (PPP) a condition separate from psoriasis, and several authors maintain that PPP is a reactive process to metal contact allergies independent from psoriasis.
Objectives:
To evaluate the frequency of allergies and psoriasis in patients with PPP and to determine the role of allergens in PPP.
Methods:
A systematic search of the English databases (PubMed and Web of Science) from January 1964 to August 2018 to identify all patients affected by PPP and allergies and/or psoriasis.
Results:
In total, 16 publications describing a total of 519 patients with PPP were evaluated and 122 cases of concomitant PPP and metal allergy were found. The frequency of allergies among patients with PPP was 22.7%; between the identified allergens, 84.3% of cases correspond to metal allergies. In 65.1% of metal allergies, an improvement in PPP was seen after withdrawal of contact. The concomitant presence of psoriasis was recorded in 18% of the cases.
Conclusion:
There is some evidence to support the association of PPP with metal allergies but also with psoriasis, suggesting the role of metal allergens as a trigger factor in patients with PPP.
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