What is Pustulosis Palmaris et Plantaris?
Pustulos palmaris et plantaris is a skin condition characterized by its unique pattern of formation. While it is very similar in nature to psoriasis, and is considered a sub-category of psoriasis, it only afflicts the palms of the hands and the soles of the feet. The affliction, while similar to psoriasis, frequently also consists of raised areas of skin called vesicles, which are similar to pustules. These vesicles are frequently filled with neutrophyls, a plentiful sort of white blood cell—that is erroneous, and not required in the vesicle. Pustulosis palmaris et plantaris can be quite painful and make it difficult to use one’s hands or walk, making treatment an acute necessity for many suffering from it.
Who gets Pustulosis Palmaris et Plantaris?
Pustulosis palmaris et plantaris is effectively a psoriasis condition. As consequence, many of the predisposing factors that apply to psoriasis also apply to pustulosis palmaris et plantaris. Some of these factors are, however, somewhat contradictory, as will be explained.
Psoriasis-type conditions are thought to be at least somewhat autoimmune. This is because immunosuppressants, drugs that keep the immune system from functioning as effectively, are known to suppress the spread of psoriasis and force it to subside. Pustulosis palmaris et plantaris follows this pattern. It follows that because autoimmune conditions have a tendency to come in clusters, individuals suffering from an autoimmune condition already are more likely to later develop pustulosis palmaris et plantaris. Individuals already suffering from psoriasis vulgaris are not necessarily more likely to go on to develop pustulosis palmaris et plantaris, however; while the two may overlap, they do not necessarily correlate.
This is, however, somewhat paradoxical. While pustulosis palmaris et plantaris and psoriasis conditions in general can be treated with immunosuppressants, they are also more likely to come up in individuals that are immunocompromised. Individuals with late-stage HIV comprise roughly 1% of all psoriasis cases. While this statistic may seem insignificant, it must be understood that more than 30% of individuals suffering from late stage HIV develop a psoriasis condition. It would seem that individuals whose immune systems are effectively destroyed would be relatively safe from the machinations of an overactive, harmful immune system, but this does not seem to be the case.
What causes Pustulosis Palmaris et Plantaris?
The cause of pustulosis palmaris et plantaris is not fully understood. As a psoriasis condition, it is somewhat nebulous. Because it responds to immunosuppressive treatments by remitting, or at least slowing its spread, it may seem that it is an autoimmune condition spurred purely by the actions of an overzealous immune system causing harm through its responses to a nonexistent problem.
The primary difficulty with this theory is the incidence of psoriasis conditions, including pustulosis palmaris et plantaris, in patients who are severely immunocompromised. Individuals suffering from late-stage HIV are likely to suffer from some form of psoriasis (likely psoriasis vulgaris, the most common form). This causes something of a paradox, as immunocompromised individuals should be fairly safe from such an autoimmune reaction.
It is difficult to elucidate a specific cause without a controlled study. However, a controlled study for a chronic condition that cannot be predicted is almost a catch-22 in and of itself; you can’t study where it comes from without having an individual who doesn’t already suffer from it start to suffer from it, but there is no way to predict who will go on to suffer from it because no studies can be effectively conducted with relation to its direct cause.
What does Pustulosis Palmaris et Plantaris cause?
Pustulosis palmaris et plantaris causes the characteristic formation of plaques on the palms and soles, as with all psoriasis conditions. More notably and extensively, however, pustulosis palmaris et plantaris causes the formation of vesicles.
Vesicles are very similar to pustules. Pustules specifically hold pus, much like blisters. They are an immune response, and frequently accompany psoriasis. Vesicles contain fluids, but not necessarily pus. In this case, the vesicles carry neutrophyls, the most common form of white cell. These white cells usually are deployed in response to an infection, and are used to destroy invaders (hence the name ‘neutro’, as in ‘neutralize’). In pustulosis palmaris et plantaris, however, these neutrophyls have no purpose and no infection to respond to. Their deployment and residence in the vesicles is erroneous.
These vesicles, accompanied with whatever psoriasis-type symptoms may also be deployed, can make the use of the hands and feet very uncomfortable, if not difficult, if not impossible, depending upon the severity. It can be very painful to walk with extensive vesicle formation on the feet. Pressure on the hands can be somewhat easier to avoid, but plaques can greatly restrict the flexibility of the hands and fingers.
Vesicles, if broken, are very likely to scar. If broken, they will become open sores which may become infected quite easily if not cared for carefully.
Pustulosis palmaris et plantaris is chronic, but is not defined as progressive. However, it may still grow worse over time, as well as remit without warning or apparent reason.
How serious is Pustulosis Palmaris et Plantaris?
Pustulosis palmaris et plantaris is a serious skin condition, although it has no potential to be fatal. The serious nature of pustulosis palmaris et plantaris stems from its chronic nature; as a chronic condition, it does not go away on its own and cannot be cured. It may be made to remit, but remission is frequently followed by recurrence. While it may remit and simply not recur again during the lifespan of the individual suffering from it, the odds of this are very slim. Thankfully, pustulosis palmaris et plantaris can be managed with medical treatment. Pustulosis palmaris et plantaris becomes much more serious when medical treatment cannot be administered for reasons of availability, and may grow worse with time.
Pustulosis palmaris et plantaris can be debilitating. Nearly every occupation in the world can be hampered by pustulosis palmaris et plantaris, should the case be severe enough; it can make it difficult to walk, carry objects of any sort, or even type. This nullifies almost every blue collar job under the sun that requires working with one’s hands, as well as every white collar job that requires typing.
What does Pustulosis Palmaris et Plantaris treatment look like?
Treatment for pustulosis palmaris et plantaris consists primarily of immunosuppressants. Immunosuppressants are very effective at forcing pustulosis palmaris et plantaris to remit, under good conditions. Under less-than-ideal conditions, it can at least make pustulosis palmaris et plantaris more manageable to some degree, which will hopefully be tangible. However, the application of immunsuppressants always carries with it the risk of infection. It is difficult to suppress one’s immune system without unfortunate consequence. Even so, this can be managed by a trained medical professional, and this is the default treatment, and the treatment that strikes closest to the heart of the problem.
Wearing snug gloves or socks may help to nullify some of the discomfort felt due to the vesicles, and may help to insulate them against rupture or irritation that will exacerbate them. However, individuals with more sensitive skin may find that this actually increases irritation, so it is best to be cautious when trying this method.
A moisturizing lotion may soothe irritation and keep skin otherwise stiffened by plaques softer and more pliable. This can increase mobility and ideally can mitigate some of the frustration. However, this will do little to keep the plaques from spreading and will do little, if anything, for the formation of vesicles.
Anti-inflammatories may be applied in the instance that the inflammation becomes severe enough to warrant its own treatment. This anti-inflammatory will likely be some form of corticosteroid and will probably be delivered by way of injection directly into the inflamed area. This contrasts with generalized psoriasis conditions, in which steroids prescribed may be administered orally; because pustulosis palmaris et plantaris only forms on the hands and feet, there is no need to treat the entire body for an outbreak.
How do I know if I have Pustulosis Palmaris et Plantaris?
Pustulosis palmaris et plantaris is very easily identified by its appearance on the palms and soles. Pustulosis palmaris et plantaris is very similar to psoriasis, resulting in the thickening of the skin and formation of plaques in some cases, but the centerpiece symptom that denotes pustulosis palmaris et plantaris is the formation of vesicles. These vesicles are distinct from pustules and may be somewhat painful. As raised bumps on the skin, they will probably be erythmatic—that is, red.
Pustulosis palmaris et plantaris can be distinguished from other, similar conditions by its location. While most forms of psoriasis spread throughout the entire skin indiscriminately, pustulosis palmaris et plantaris isolates itself to the palms and soles. Should the condition manifest elsewhere, it is not a case of pustulosis palmaris et plantaris (although pustulosis palmaris et plantaris may manifest concurrently with other psoriasis conditions; there is nothing that says they cannot coexist).