Palmoplantar Pustulosis - Symptoms, Causes & Treatment
Medically reviewed by Dr. Anand S. Urhekar, MD, MD Pathology, Clinical Advisor · Last updated July 2026
A chronic condition producing crops of sterile yellow-brown pustules on the palms and soles, on a background of red, scaly, fissured skin. It is closely related to psoriasis, strongly associated with smoking, and often painful enough to limit walking and manual work.
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Quick Answer
Palmoplantar pustulosis produces recurring crops of sterile yellow pustules on red, scaly palms and soles, which dry into brown spots. Smoking is by far the strongest associated factor and stopping is the single most useful intervention. Treatment includes potent topical steroids under occlusion, vitamin D analogues, acitretin, phototherapy and specialist systemic therapy for severe disease.
Symptoms
- Crops of yellow sterile pustules on palms and soles
- Pustules drying to brown scaly spots
- Red, thickened, scaly and fissured skin
- Pain when walking or gripping
- Chronic relapsing course over years
Causes & Risk Factors
- Strongly associated with smoking (present in the majority of patients)
- Related to psoriasis; shares immune pathways
- Thyroid autoimmunity in some patients
- Focal infection and stress may trigger flares
Treatment & Management
- Smoking cessation — the most impactful single measure
- Potent topical corticosteroid, often under occlusion
- Vitamin D analogues and coal tar preparations
- Oral acitretin, ciclosporin or methotrexate
- PUVA phototherapy or targeted biologic therapy in specialist care
When to See a Doctor
See a doctor if pustules on the palms or soles are recurrent, painful or limiting daily activity. Sudden fever with widespread pustules requires urgent assessment.
Frequently Asked Questions
Are the pustules infected?
No — they are sterile, containing inflammatory cells rather than bacteria. Antibiotics do not help, which is why the condition is often misdiagnosed and mistreated for months.
Does quitting smoking really help?
Yes. Smoking is present in most patients at onset and continued smoking is associated with more severe, treatment-resistant disease. Improvement after quitting can take many months but is well documented.
Medical References
Information on this page is sourced from and verified against reputable medical resources:
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Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. The content on this page should not be used to diagnose or treat any health problem. Always consult with a qualified healthcare professional for proper medical evaluation, diagnosis, and treatment of your condition.