pustulosis palmaris et plantaris
TRANSCRIPT
248
© 2000 European Academy of Dermatology and Venereology
EDITOR IAL
JEADV
(2000)
14
, 248
Blackwell Science, Ltd
Pustulosis palmaris et plantaris
Peter CM
van de Kerkhof
Department of Dermatology, University Medical Centre Nijmegen, PO Box 9101, NL-6500HB Nijmegen, The Netherlands. tel. +31 24 361 3247;
fax +31 24 354 1184; E-mail: [email protected]
Gambicher T.
et al
. Sweet’s syndrome with eruption of pustulosis palmaris.
JEADV
14
, 327–329.
Sterile pustules on the palms and soles have caused a nos-
ological debate for decades.
1
Pustulosis palmaris et plantaris
has been associated with palmoplantar psoriasis. On the other
hand, pustulosis palmaris et plantaris has been proposed as
a distinct disease entity by many authors.
Andrews has described pustulosis palmaris et plantaris
as an aspecific response pattern to bacterial products.
2
Indeed,
some reports suggest that treatment with antibiotics may cause
an improvement of this skin condition.
Histopathological investigation of the pustules suggest a
similarity with the micropustules of Kogoj. Indeed, the wall of
pustules in pustulosis palmoplantaris is spongiform: the kerat-
inocytes show an eosinophylic network of keratinocyteremnants,
intermingled with polymorphonuclear leucocytes.
3
The co-occurance of pustulosis palmoplantaris with
psoriatic lesions elsewhere is debatable.
4,5
Some authors report
an increased occurrance of psoriatic lesions elsewhere in the
well known frequency of 2% for occurrence of psoriatic lesions
on other sites.
The association with HLA antigens is not compatible with a
genetic association with psoriasis. HLA-B13 and B17 are not
associated with pustulosis palmaris et plantaris.
6–8
Treatment of pustulosis palmoplantaris largely follows the
principle of treatment of pustular psoriasis. However, systemic
treatments are often required.
Association of pustulosis palmoplantaris with conditions,
other than psoriasis may reveal further insights into the
aetiopathogenesis of this condition. In this issue of the JEADV
(
14
: 327–329), Sweet’s Syndrome with eruption of pustulosis
palmaris is described.
9
It is attractive to hypothesise that
pustulosis palmaris et plantaris is a response pattern in
genetically predisposed patients to neutrophil activation, either
bacterial, part of the psoriasis response pattern, or as part of
neutrophilic disorders such as Sweet’s syndrome.
References
1 Van de Kerkhof PCM, Kuijpers ALA, Koopmans-Feind A. On the
nosology of palmoplantar psoriasis.
J Eur Acad Dermatol Venereol
1998;
10
: 184–186.
2 Andrews GC, Machacek GF. Pustular bacterials of the hands and
feet.
Arch Dermatol Syphilol
1935;
32
: 837–847.
3 Van de Kerkhof PCM. Clinical features. In: Van de Kerkhof PCM,
editor.
Textbook of psoriasis
. Blackwell Science, Oxford, 1999: 3–29.
4 Ashurst PJC. Relapsing pustular eruptions of hands and feet.
Br J Dermatol
1964;
76
: 169–180.
5 Hellgren L, Mobacken H. Pustulosis palmaris et plantaris.
Prevalence, clinical observations and prognosis.
Acta Derm
Venereol
1971;
51
: 284–288.
6 Karvonen J, Tiilikainen A, Lassus A. HLA antigens in psoriasis.
In: Farber EM, Cox AJ, Jacobs PA, Nail ML, editors.
Psoriasis.
Proceedings of the 2nd International Symposium
. Yorke Medical
Books, New York, 1977: 405–408.
7 Ward JM, Barnes RMR. HLA antigens in persistent palmoplantar
pustulosis and its relationship to psoriasis.
Br J Dermatol
1978;
99
:
477–483.
8 Zachariae H. Significance of pustular reaction in psoriasis.
In: Farber EM, Cox AJ, Jakobs PH, Nail LM, editors.
Psoriasis
Proceedings of the 2nd Int Symposium
. Yorke Medical Books,
New York, 1977: 163–170.
9 Gambichler T, Menzel S, Waiter M. Sweet’s syndrome with
eruption of pustulosis palmaris.
J Acad Dermatol Venereol
2000;
14
: 327–329.
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