Palm and plantar pustulosis.

The term "palmar-plantar pusgulosis" is interpreted very broadly in the literature.

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Epidemiology

The disease occurs more often in women over 40 years of age.

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Causes palm and plantar pustulosis.

Some authors include any non-infectious pustular rashes on the hands and feet under this term. Others exclude persistent purulent acrodermatitis of Hallopeau from this group, while others classify only forms unrelated to either common or pustular psoriasis as palmoplantar pustulosis. Finally, there is a point of view that palmoplantar pustulosis is a pustular variety of common psoriasis. Some believe that, in terms of clinical and morphological manifestations, palmoplantar pustulosis is closer to Andrews' bacterid.

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Pathogenesis

Mild acanthosis, hyperkeratosis, initially subkeratinous pustules, then as the pustules increase in volume they occupy almost the entire thickness of the epidermis, filling with neutrophilic granulocytes. There are no spongiform pustules. In the dermis under the pustules there is a massive inflammatory infiltrate consisting of neutrophilic granulocytes and lymphocytes.

Histogenesis of palmoplantar pustulosis

Electron microscopic examination revealed a large number of tonofilament bundles in all layers of the epidermis. The granular layer contained a significant amount of mature keratohyalin granules; epithelial cells were poor in organelles. The stratum corneum was close to normal in structure, but the marginal stripe was weakly expressed or completely absent. The number of vessels was increased in the papillary and upper part of the reticular layer of the dermis. The endoplasmic reticulum with expanded cisterns, mitochondria with a dense matrix, and many ribosomes were well developed in the epithelial cells and pericytes, indicating increased synthetic processes in them. The transport function was reduced, which was confirmed by a decrease in the number of pinocytotic vesicles and vacuoles. The infiltrate consisted of lymphocytes, histiocytes, neutrophilic granulocytes, and tissue basophils.

Immunomorphological examination of the skin revealed immunoglobulins G and M in the pustules and in the intercellular spaces near them. Complement components C3a and C5a, which have chemoattractant properties, were found in the scales. Changes in the phagocytic activity of neutrophil granulocytes and their surface receptors were established. The above data indicate a significant increase in chemotaxis, which explains the formation of pustules.

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Symptoms palm and plantar pustulosis.

The course of palmoplantar pustulosis is chronic, recurrent, with short-term remissions. The central part of the palms and soles is affected. At first, the rash may be unilateral. Fresh pustules are accompanied by a weak inflammatory reaction, but then the erythema becomes more distinct, its borders are not sharp. During development, the color of the pustules changes from yellow to brown (when drying). Then peeling in the form of a collar is noted. Cases of generalization of rashes, the occurrence of the disease in connection with the use of drugs of various groups are described.