REFERAT

Palmoplantar Pustulosis
Supervisor: dr. Sukma Anjayani, M.Kes, Sp.KK

By: Andi Rahman Mujito 11 16 777 14 130

Fierda Putri Pratiwi 12 777 006
DEFINITION

 Palmoplantar pustulosis is a chronic pustular

dermatosis that localized only on palm and sole

 It’s characterized by high resistance to

treatment and high number of recurrence
EPIDEMIOLOGY

 Women > Men = 3: 1

 The highest incidence is in the age of 20-60

years

 Rarely found in people over 60 years

ETIOPATHOGENESIS

 The cause of palmoplantar pustulosis still remains

unclear

 Imbalance protease /antiprotease on skin that

consist from reduction activity antileukoprotease
(elafin/ SKALP) already discussed as mechanism
that maybe caused pustules formation
CLINICAL FINDING

 The initial lesion is pustules with size 2-4mm

 Lesions usually appear symmetrical but there is aslo
unilateral. Lesions surrounded by erythematous
 The symptom that could appear is feeling itch and
burning
 On severe eruption may be painful so the patient is
disable to stand and walk
 Pustuls 2-3mm, eritomatous skin on both of
palms
 Pustuls 2-3mm, eritomatous skin on sole
 Sometimes pustul spread to proxymal hand. A
few days after pustules formed, lesion will dry,
equally, and brown.
PHYSICAL EXAMINATION

 On physical examination can be found pustules

and scalling
 The size of lesion is around 2-4 mm
 The base of the lesion is red colored and may
be scalling
 The lesions only spread in palms and soles
PROMPT EXAMINATION

1. Histopathologic finding
 The intraepidermal space is filled with
polymorphonuclear cells that is related with
spongiform change in surround epidermis layer.
The amount of eosinophils and mast cell
increases on PPP biopsy from skin lesions
2. Laboratory

 There is an increase in leukocytes. Other

examination is usually within normal limits
MANAGEMENT

 There is no any therapy guidieline yet for

Palmoplantar pustulosis. The therapy can be
given based on psoriasis management
1. Systemic
a. Acitretin 25-50 mg per day given 3-6 months
b. Methotrexat 0.1-0.3 mg / kg administered once a
week for 4-8 weeks
c. Alitreinoin 30mg per day for 12 weeks
d. Colchicine 1-2 mg per day administered once daily
for 8 weeks
e. Itraconazole 100mg per day administered once
daily for 8 weeks
2. Topical
a. Topical corticosteroids given 40-50mg once
daily for 2 weeks
b. Calcipotriol maximum dosage is 100mg a
week and not given more than 6 weeks
c. PUVA is usually given with frequency 311-313
nm twice a week for 10 weeks
d. Moisturizer oinment
DIFFERENTIA DIAGNOSES

 Eczema dermatitis
 Tinea manus
PROGNOSIS

 The disease tend to be chronic and remission

until several months. It could recur even only
several days after the therapy is stopped.
THANK YOU