Study on clinical, histopathological and dermoscopic features of palmoplantar pustulosis and palmoplantar psoriasis with pustules


  • Neethu M. George Consultant Dermatologist, Marsleeva Medicity, Pala. Kerala, India
  • Prabhakar M. Sangolli Sri Siddhartha College of Medical Sciences and Research Centre, T Begur, Bangalore, Karnataka, India
  • Rosamma Thomas Pathologist and Director of Laboratory Medicine, Marsleeva Medicity, Pala, Kerala, India
  • Jerry R. John Department of Community Medicine, Al Azhar Medical College and Super Speciality Hospital, Kerala, India



Psoriasis, Vesicles, Pustules, Dermoscopy, Palmoplantar pustulosis


Background: Palmo-plantar pustulosis (PPP) and palmoplantar psoriasis with pustules (PPso)/Palmoplantar pustular psoriasis are entities that present with chronic cyclical eruptions of vesicles and pustules of palms and soles, which were initially considered to be similar but was defined as separate entities by the international psoriasis council in 2007. Individuals with PPP are at increased risk of psoriasis vulgaris, psoriatic arthritis, autoimmune thyroid disease and 90% of pustulosis patients can have psoriasis-like rash at some stage of the disease. Aim was to assess the clinical, histopathological and dermoscopic features of PPP and palmoplantar psoriasis with pustules.

Methods: A cross sectional analysis of all patients who presented to us over 1 year with vesicles and/or pustules of hands and/or feet and were diagnosed with PPP and palmoplantar psoriasis with pustules/palmoplantar pustular psoriasis, both clinically and histologically, were done. The severity was analysed using palmoplantar pustulosis area severity index (PPPASI) and the clinical, histological and dermoscopic features were noted.

Results: Twenty-four patients were categorized into 2 groups of 12 each, with a male predominance in both the groups. Majority (66.6%) of PPP belonged to the age group of 20-40 years whereas 83% of PPso belonged to >40 years of age. Dermoscopic findings noted in both groups were translucent yellow areas, yellow/red-brown globules, dotted regularly arranged vessels, yellow crust and globules following dermatoglyphics.

Conclusions: The study, though with limited sample size, highlights few clinical, histopathological and dermoscopic features which helps in differentiating the two groups.


Trattner H, Blüml S, Steiner I, Plut U, Radakovic S, Tanew A. Quality of life and comorbidities in palmoplantar pustulosis-a cross-sectional study on 102 patients. J Eur Acad Dermatol Venereol. 2017;31(10):1681-5.

Kikuchi N, Yamamoto T. Dental infection as a triggering factor in palmoplantar pustulosis. Acta Derm Venereol. 2013;93(6):721-2.

Vasudevan B, Das P, Bhatt S. Pustular psoriasis: A distinct aetiopathogenic and clinical entity. Indian J Dermatol Venereol Leprol. 2023;90(1);19-29.

Navarini AA, Burden AD, Capon F, Mrowietz U, Puig L, Köks S et al. ERASPEN Network. European consensus statement on phenotypes of pustular psoriasis. J Eur Acad Dermatol Venereol. 2017;31(11):1792-9.

Barber HW. Acrodermatitis continua vel perstans (dermatitis repens) and psoriasis pustulosa. Br J Dermatol. 1930;42:500-18.

Griffiths CE, Christophers E, Barker JN, Chalmers RJ, Chimenti S, Krueger GG et al. A classification of psoriasis vulgaris according to phenotype. Br J Dermatol. 2007;156(2):258-62.

Paik K, Kim BR, Youn SW. Evaluation of the area sub score of the Palmoplantar Pustulosis Area and Severity Index using an attention U-net deep learning algorithm. J Dermatol. 2023;50(6):787-92.

Raposo I, Torres T. Palmoplantar Psoriasis and Palmoplantar Pustulosis: Current Treatment and Future Prospects. Am J Clin Dermatol. 2016;17(4):349-58.

Masuda-Kuroki K, Murakami M, Kishibe M, Kobayashi S, Okubo Y, Yamamoto T et al. Diagnostic histopathological features distinguishing palmoplantar pustulosis from pompholyx. J Dermatol. 2019;46(5):399-408.

Rao A, Khandpur S, Kalaivani M. A study of the histopathology of palmo-plantar psoriasis and hyperkeratotic palmo-plantar dermatitis. Indian J Dermatol Venereol Leprol. 2018;84(1):27-33.

Ankad BS, Reshme AS, Nikam BP, Drago ND. Dermoscopic differentiation of pustular psoriasis and tinea incognito. Clin Dermatol Rev 2020;4(2):136-40.

Oktem A, Uysal PI, Akdoğan N, Tokmak A, Yalcin B. Clinical characteristics and associations of palmoplantar pustulosis: an observational study. An Bras Dermatol. 2020;95(1):15-9.

Benzian-Olsson N, Dand N, Chaloner C. Association of Clinical and Demographic Factors with the Severity of Palmoplantar Pustulosis. JAMA Dermatol. 2020;156(11):1216-22.

Brunasso AMG, Massone C. Recent advances in palmoplantar pustulosis. Fac Rev. 2021;27(10):62.

Brunasso AMG, Puntoni M, Aberer W. Clinical and epidemiological comparison of patients affected by palmoplantar plaque psoriasis and palmoplantar pustulosis: A case series study. Br J Dermatol. 2013;168(6):1243-51.

Eriksson MO, Hagforsen E, Lundin IP, Michaëlsson G. Palmoplantar pustulosis: a clinical and immunohistological study. Br J Dermatol. 1998;138(3):390-8.

Hiraiwa T, Yamamoto T. Nail involvement associated with palmoplantar pustulosis. Int J Dermatol. 2017;56:e28-9.

Martinez-Rico JC, Gomez-Flores M, Ocampo-Candiani J, Villarreal-Martinez A, Chavez-Alvarez S. New dermoscopic finding for palmoplantar psoriasis: flowers. Australas J Dermatol. 2020;61(3):257-8.

Adya KA, Inamadar AC, Palit A. Dermatoses with “collarette of skin”. Indian J Dermatol Venereol Leprol 2019;85(1):116-24.

Krieg PH, Bacharach-Buhles M, El-Gammal S, Altmeyer P. The pustule in palmoplantar psoriasis: transformed vesicle or mature microabscess? A three-dimensional study. Dermatology. 1992;185(2):104-12.






Original Research Articles