Palmo-Plantar Pustulosis (PPP)

Authored by CalamityJane

Description of Palmo-Plantar Pustulosis

PPP (palmo-plantar pustulosis) is a Psoriasis cousin. It initially presents as small pustules on the hands and/or feet, or just one hand/or foot. If not treated the pustules can form into a 'stream' as they join together. Burst pustules produce a greenish/yellow substance often thought to be bacterial (because of the colour). PPP happens when immature skin cells come to the surface before maturity. In about 4 days vs about 28 is my understanding.

PPP is often confused by the sufferer as well as doctors, with Dyshidrotic Eczema aka Pompholyx. The difference is in the colour of the pustule/blisters contents. Pompholyx has clear blisters, PPP has yellow/green pustules. The colour of the pustules in PPP is clearly visible without them having burst.

Pustules need to be swabbed by a doctor or dermatologist; sent to a lab to be tested for both bacteria and fungus. The swab result will be negative for both bacteria and fungus. A swab is crucial for proper diagnosis and treatment.

Causes & Treatments of PPP

Initial treatment is usually a steroid cream, and occlusion by wrapping the area with plastic wrap to increase by about 5 times the absorption of the product. Other topical treatments include tar as well as inhibitant Dovonex. Pustules burst, then crust over and peeling skin is the result. At this stage skin can often crack and form fissures. Heavy moisturizing cream goes hand-in-hand with a PPP diagnosis.

If the PPP is very stubborn and does not respond to topical treatments oral drugs are sometimes suggested. Oral drugs for this condition can have quite severe side effects, so discretion and knowledge is key. Sometimes oral antibiotics are prescribed. The dermatologist and patient should discuss all of these options.

As with many skin conditions each person is different and can present with different symptoms. Some people itch while others do not for example. What works for one person may not work for another. Please refer to your dermatologist for any advice as to what could work for you.