Recent advances in palmoplantar pustulosis

Area of Science:

• Dermatology
• Immunology
• Rheumatology

Background:

• Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease characterized by sterile pustules and keratotic lesions on palms and soles.
• Considered a variant of pustular psoriasis, PPP affects 0.050-0.12% of the population, predominantly women aged 50-69.
• Associated conditions include nail psoriasis, psoriatic arthritis, SAPHO syndrome, and potential comorbidities like thyroid disease and diabetes.

Purpose of the Study:

• To review the current understanding of Palmoplantar Pustulosis (PPP).
• To explore the immunological underpinnings and associated conditions of PPP.
• To identify potential triggers and discuss current treatment limitations.

Main Methods:

• Literature review of existing studies on Palmoplantar Pustulosis.
• Analysis of epidemiological data, clinical presentations, and associated disorders.
• Examination of immunological markers and environmental/genetic factors.

Main Results:

• PPP involves activated innate and adaptive immune systems, with elevated inflammatory molecules like IL-17 and IL-22 in skin and serum.
• Eccrine sweat glands are implicated as immune-competent structures in PPP pathogenesis.
• Identified potential triggers include smoking, stress, infections, allergies, and genetic predisposition, with oral/tonsillar infections being significant.

Conclusions:

• Palmoplantar Pustulosis is a complex inflammatory condition with significant immune system involvement.
• Further research is needed to confirm associations with comorbidities and establish optimal long-term treatment strategies.
• Understanding triggers and immune pathways is crucial for managing PPP effectively.