Subscribe to our dermatology newsletter


Palmoplantar pustulosis

Author: Hon Assoc Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1997. Reviewed and updated, September 2014.

What is palmoplantar pustulosis?

Palmoplantar pustulosis is a chronic pustular condition affecting the palms and soles. It is also called pustulosis palmaris et plantaris.

A variant of palmoplantar pustulosis affecting the tips of the digits is called acrodermatitis continua of Hallopeau or acropustulosis.

What are the clinical features of palmoplantar pustulosis?

Palmoplantar pustulosis presents as crops of sterile pustules occurring on one or both hands and/or feet. They are associated with thickened, scaly, red skin that easily develops painful cracks (fissures).

Palmoplantar pustulosis varies in severity and may persist for many years. The discomfort can be considerable, interfering with work and leisure activities.

Certain manual occupations or occupations involving much walking are inadvisable for affected individuals.

More images of palmoplantar pustulosis ...

Conditions associated with palmoplantar pustulosis

Certain conditions have been reported to occur in patients with palmopustular pustulosis more often than in unaffected patients.

Palmoplantar pustulosis may rarely be provoked by the tumour necrosis factor alpha medicines (infliximab, adalimumab, etanercept).

What is the cause of palmoplantar pustulosis?

The exact cause of palmoplantar pustulosis is unknown. There have been several theories.

The majority of patients with palmoplantar pustulosis are current smokers and in those that have smoked in the past (65–90%). It is thought that activated nicotine receptors in the sweat glands cause an inflammatory process.

How is palmoplantar pustulosis diagnosed?

Palmoplantar pustulosis is generally diagnosed clinically.

What is the treatment of palmoplantar pustulosis?

Treatment of palmoplantar pustulosis does not cure the disorder and is not always successful. The following may be helpful.

General Measures


Topical steroids
Topical steroids are anti-inflammatory agents which range in potency and vehicle. Only the strongest ointments are effective in conditions affecting the thick skin of the hands and feet. However the very potent products such as clobetasol proprionate should be used only for limited periods or else side effects and loss of efficacy become a problem.

A thin smear should be applied twice daily to the affected area. The effect may be enhanced by using plastic occlusion for a few hours or even overnight – use polythene gloves, plastic bags or cling film. Do not use occlusion for more than 5 days in a row.

Coal Tar
Crude coal tar is very messy but applied directly to the pustules every five days or so can stop them occurring. Paint on carefully and cover. It can be mixed in an ointment base for easier application.

Acitretin tablets, derived from Vitamin A, can control palmoplantar pustulosis in the majority of users. They have a number of potentially serious side effects so are only suitable for significantly disabled patients. A newer retinoid, alitretinoin, may also be effective.

Narrowband UVB and photochemotherapy (the combination of exposure to ultraviolet radiation (UV-A) with psoralens taken as tablets or applied topically—bathwater PUVA—can be very effective. Careful supervision is necessary to avoid burning.

Other treatments
A variety of other medications can help some subjects including:

Although they sometimes induce palmoplantar pustulosis as a side effect of treatment, biologics are occasionally effective when used for severe palmoplantar pustulosis.

Related information

Email Newsletter

Would you like to receive our dermatology updates by email?


Submit your images

We're seeking high-quality photos of skin diseases.  


Skin lesion photography

Watch Dr Amanda Oakley presenting "Skin lesion photography" at The Australasian Skin Cancer Congress.

Subscribe to our mailing list

* indicates required
DermNet NZ Newsletter