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Palmoplantar Pustulosis and Psoriasis: Pictures, Symptoms, and Treatment

Medically reviewed by Steven Devos, M.D., Ph.D.
Written by Joan Grossman
Posted on January 5, 2024

If you’ve had breakouts of itchy, scaly, or painful blisters on the soles of your feet or the palms of your hands, you may have palmoplantar pustulosis (PPP). Anywhere between 2.8 percent and 40.9 percent of people with psoriasis also have palmoplantar pustulosis, according to an analysis of multiple studies. Researchers are still trying to understand this rare disorder. It’s often classified as a form of psoriasis, but some medical researchers consider palmoplantar pustulosis a separate skin disorder. Other names for the condition include chronic palmoplantar pustular psoriasis and pustulosis palmoplantaris.

PPP flare-ups are often debilitating. MyPsoriasisTeam members who are living with palmoplantar pustulosis have shared their experiences and frustrations. “I have palmoplantar pustulosis psoriasis — trying to learn everything I can. So far trying diet changes, stress control, natural remedies, and moisturizer creams,” a member wrote. “I have one flare-up after another. The prospect of this spreading and getting worse isn’t comforting.”

Another member said, “I have palmoplantar psoriasis and am in a huge flare. I can barely hold a cup!!! It makes everything seem 100 times harder. I guess the only good thing is no dishes.”

If you have palmoplantar pustulosis — or think you might — be sure to talk with your dermatologist. Although this condition can sometimes be challenging to manage, there are treatments that may help. Read on to learn more about palmoplantar pustulosis and how it may affect people with psoriasis.

Recognizing Palmoplantar Pustulosis Symptoms

Palmoplantar pustulosis is sometimes considered the most common type of localized pustular psoriasis. It specifically affects the palms of the hands and soles of the feet, as opposed to generalized pustular psoriasis, which can show up anywhere on the body. PPP symptoms that may develop on your palms and soles include:

  • Sterile pustules — Germ-free, noncontagious pus-filled blisters
  • Thick plaques — Patches of thick, discolored skin that may resemble plaque psoriasis
  • Itching
  • Pain or a burning sensation
  • Scaly skin that may turn brown, depending on your skin tone
  • Fissuring — Cracked skin
Palmoplantar pustulosis can cause severe blistering of the palms, making it hard to perform daily activities that require the use of your hands. (CC BY-NC-ND 3.0 NZ/DermNet)


Palmoplantar pustulosis can significantly affect your quality of life. The painful cracks and lesions can make daily activities such as walking, standing, and using your hands difficult. PPP symptoms may be worsened by weather changes, pressure or friction, manual labor, or household chores that involve detergents or other irritants. Protective gloves can help protect your palms.

When palmoplantar pustulosis develops on the soles of the feet, walking becomes painful and difficult. (CC BY-NC-ND 3.0 NZ/DermNet)


Palmoplantar pustulosis can resemble other skin disorders, which may make it difficult to diagnose. These conditions include acrodermatitis continua of Hallopeau, a related skin disease, and the following skin disorders:

  • Contact dermatitis
  • Dyshidrotic eczema
  • Pityriasis rubra pilaris
  • Palmoplantar keratoderma

Although palmoplantar pustulosis refers to a condition on the palms or soles, other areas of the body, particularly the nails, may be affected as well. Approximately 24 percent of people with palmoplantar pustulosis also have some type of psoriasis on another part of the body.

Toenails and fingernails may also be affected by palmoplantar pustulosis. (CC BY-NC-ND 3.0 NZ/DermNet)


One MyPsoriasisTeam member wrote, “I also have palmoplantar psoriasis, and mine has spread fairly rapidly. I have also noticed two small patches on my arm. My family doctor thought it was psoriasis coming in there also. The new ones on my arm don’t look like much yet, so I’m not sure what is going to happen.”

Causes and Risk Factors

Palmoplantar pustulosis is a chronic (ongoing) skin disease that can come and go over time. Like other types of psoriasis, palmoplantar pustulosis is an inflammatory disorder that’s believed to be caused by an overreacting immune system, which mistakenly attacks healthy tissue.

Although medical researchers don’t fully understand palmoplantar pustulosis, they have several theories about its possible causes, including:

  • Disorders in the eccrine sweat glands, which are prevalent in hands and feet
  • Genetic variants or mutations (changes)
  • Bacterial infections such as chronic sinusitis, chronic or acute tonsillitis, and dental infections
  • Contact allergic reaction to some metals

Some dermatology research has indicated that in some people, palmoplantar pustulosis may occur as a rare but severe side effect of a drug. Tumor necrosis factor-alpha inhibitors, a type of biologic medication used in the treatment of psoriasis and other chronic inflammatory conditions, may be a factor in some PPP cases.

Other drugs have been investigated as potential causes of generalized pustular psoriasis, including:

Risk Factors for Palmoplantar Pustulosis

Women are 3.5 times more likely to develop palmoplantar pustulosis than men are, according to the National Psoriasis Foundation. Approximately 80 percent of people who develop the condition use tobacco or did in the past. Smoking is associated with inflammation and vascular damage (affecting the blood vessels) in the skin.

A family history of psoriasis is found in approximately 10 percent to 42 percent of people with palmoplantar pustulosis.

Complications Linked to Palmoplantar Pustulosis

People with palmoplantar pustulosis have a risk of developing some of the same comorbidities (coinciding conditions) that occur in people with psoriasis, including cardiovascular disease, metabolic disorders, and psychiatric conditions. However, the risks are higher for some conditions and lower for others.

Compared to people with psoriasis, people with palmoplantar pustulosis have a higher risk of developing diseases such as:

  • Type 1 and type 2 diabetes
  • Allergic contact dermatitis
  • Celiac disease
  • Inflammatory bowel disease

People with palmoplantar pustulosis are less likely than people with psoriasis to develop other comorbidities, such as:

  • Psoriatic arthritis
  • Nonalcoholic fatty liver disease
  • Some skin cancers

Some complications may be serious if left untreated, so be sure to discuss your risks with your doctor.

Treatment Options for Palmoplantar Pustulosis

Palmoplantar pustulosis can sometimes be challenging to manage, but several topical and systemic treatment options, as well as light therapy, may help control symptoms. Although some PPP treatments overlap with psoriasis treatments, your doctor may recommend therapies that are specifically designated for palmoplantar pustulosis. Always discuss a new treatment in detail so that you understand exactly how it should be used and are aware of any potential side effects.

Topical therapies that are first-line treatment options include corticosteroids, sometimes with occlusion — covered to increase effectiveness — and calcipotriene cream (Dovonex). Other over-the-counter (OTC) and prescription emollients, ointments, or creams with ingredients such as coal tar, salicylic acid, and urea may be helpful for some people.

Always discuss any OTC product with your dermatologist before trying it, because some ingredients can make medications less effective. For instance, salicylic acid should not be used with calcipotriene. Topical steroids should be used only as directed to avoid unwanted side effects.

Systemic oral medications include:

  • Acitretin, an oral retinoid derived from vitamin A
  • Methotrexate, a disease-modifying antirheumatic drug (DMARD)
  • Cyclosporine, an immunosuppressant

Newer treatments with laser therapy have been reported as promising. Standard light therapies — also known as phototherapy — for palmoplantar pustulosis include psoralen with ultraviolet light A light (PUVA) and narrowband ultraviolet light B.

“I have just completed PUVA treatment for my palmoplantar pustular psoriasis,” one MyPsoriasisTeam member reported. “I would say it’s 90 percent gone. I had 32 treatments over almost five months.”

In severe cases in which palmoplantar pustulosis doesn’t respond to other treatment options, biologics may be recommended. These drugs are administered by either subcutaneous (under the skin) injection or intravenous infusion.

Home Skin Care

Along with sticking to your recommended treatment plan, focusing on home skin care can help prevent PPP flare-ups. It’s important to keep affected areas clean by washing with mild soap. Moisturize affected areas regularly, and use fragrance-free products. Identifying and avoiding triggers can also help protect skin from outbreaks of palmoplantar pustulosis.

MyPsoriasisTeam members have shared their tips for home skin care that has helped them relieve PPP symptoms.

“Cotton socks and Hydromol on for bed — I have pustular palmoplantar psoriasis on my soles and palms,” said one member. “It will help to reduce cracking.”

Another member offered this tip: “I have been using aloe vera from my homegrown plant! I peel one side of the aloe cut from the plant, trim, and place the peeled (sharp bits removed) and juicy side of the leaf on the affected arch of my foot and hold it in place with a bandage. Socks on, shoes on, and off to work. I keep this in place all day. The healing at the end of the day is unbelievable. I do the same at night on my affected hands.”

“I have found that soaking in apple cider vinegar helps soothe and heal mine,” said another member, “then also full-spectrum hemp lotion.”

Adopt a Healthy Lifestyle

A well-balanced diet along with physical activity and exercise can benefit your overall health, boost mental well-being, and may help improve PPP symptoms. Managing stress can also help reduce flare-ups. If you smoke, talk to your doctor about help with quitting.

Stay in Contact With Your Dermatologist

Maintaining good communication with your dermatologist is essential for your care. If you have palmoplantar pustulosis, let your doctor know about any new, changing, or worsening symptoms. Effective management of PPP symptoms and disease activity can help you avoid complications and feel your best.

Find Your Team

On MyPsoriasisTeam, the online social network for people with psoriasis, more than 123,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Do you have palmoplantar pustulosis? How do you manage the symptoms? Share your experiences in the comments below, or start a conversation by posting on your Activities page.

    Posted on January 5, 2024
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    Steven Devos, M.D., Ph.D. received his medical degree and completed residency training in dermatology at the University of Ghent, Belgium. Learn more about him here.
    Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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