Psoriasis with pustules of hands and feet

Palmoplantar pustular psoriasis is characterised by numerous small, sterile yellow pustules and widespread erythema localised to the palms and soles (1).

The disease may effect a single foot or hand, or the entire surface of both feet and hands.

Pustular palmoplantar psoriasis is associated with classical psoriasis vulgaris in around 25% of the patients (1).

It differs from chronic plaque psoriasis from the following factors:

• it is commonly seen in women (9:1)
  
  
• presents between the ages of 40-60 years
  
  
• a strong association with current or past smoking (1)
  
  
• prevalence of palmoplantar psoriasis varies widely in different studies, ranging from 2.8%7 to 40.9% (3)

It is a chronic condition (2). The pustules gradually change into circular, brown, scaly spots and in time, peel off (1). They are uncomfortable or painful rather than itchy.

Psoriatic nail involvement can be commonly seen in palmoplantar pustular psoriasis (1).

Click here for example images of palmoplantar pustular psoriasis

Reference:

• 1. Langley R.G.B et al. Psoriasis: epidemiology, clinical features, and quality of life. Annals of the Rheumatic Diseases 2005;64(2)
• 2. The British Association of Dermatologists 2006. General management of Psoriasis -Specific sites
• 3. Farber EM, Nall ML. Natural history of psoriasis in 5600 patients. Dermatologica 1974; 148: 1-18