Palmar-plantar pustules

The term "palm-plantar pusgulez" is widely interpreted in the literature. 

[1], [2], [3], [4],

Epidemiology

The disease is more common in women older than 40 years. 

[5], [6], [7], [8]

Causes of the palm-plantar pustule

Some authors combine under this term any non-infectious pustular eruptions on hands and feet. Others exclude from this group persistent purulent acrodermatitis Allopo, others refer to palmar-plantar pustules only forms that are not related to either ordinary or pustular psoriasis. Finally, there is a view that palmar-plantar pustulosis is a pustular variant of ordinary psoriasis. Some believe that, according to the clinical and morphological manifestations, the palmar-plantar pustulosis is closer to the Andrews bacterium.

[9], [10]

Pathogenesis

Unclear acanthosis, hyperkeratosis, the presence of at first subthreshold pustules, then as the pustules increase in volume they occupy almost the entire thickness of the epidermis, being filled with neutrophilic granulocytes. There are no spongioform pustules. In the derma under the pustules, a massive inflammatory infiltrate is expressed, consisting of neutrophilic granulocytes and lymphocytes.

Histogenesis of palmar-plantar pustules

With electron microscopy, a large number of bundles of tonofilaments have been detected in all layers of the epidermis. In the granular layer, a significant content of mature granules of keratogialin is found, epithelial cells are poor in organelles. The corneal layer is close in structure to the norm, but the marginal band is weakly expressed or completely absent. In the papillary and upper part of the mesh layer of the dermis, the number of vessels is increased. In epithelial cells and pericytes, the endoplasmic reticulum with enlarged cisterns, mitochondria with a dense matrix, and many ribosomes are well developed, which indicates the intensification of synthetic processes in them. The transport function is reduced, which is confirmed by a decrease in the number of pinocytosis vesicles and vacuoles. The infiltrate consists of lymphocytes, histiocytes, neutrophil granulocytes and tissue basophils.

Immuno-morphological examination of the skin revealed immunoglobulins G and M in pustules and in intercellular spaces near them. In the flakes, the C3a and C5a components of the complement, possessing the properties of chemoattractants, were detected. Changes in the phagocytic activity of neutrophilic granulocytes, as well as their surface receptors, have been established. The data listed above indicate a significant increase in chemotaxis, which explains the formation of pustules.

[11], [12], [13]

Symptoms of the palm-plantar pustule

The flow of palm-plantar pustules is chronic, relapsing, with short-term remissions. The central part of the palms and soles is affected. At the beginning, the rashes may be one-sided. Fresh pustules are accompanied by a mild inflammatory response, but then the erythema becomes more distinct, its boundaries are blurred. During development, the color of the pustule changes from yellow to brown (when it dries). Then there is peeling in the form of a collar. The cases of generalization of rashes, occurrence of the disease in connection with the use of drugs of various groups are described.