The Morphogenesis of Pustulosis Palmaris et Plantaris

Uehara, Masami

doi:10.1001/archderm.1974.01630040028005

Cited by 65 publications

(20 citation statements)

References 10 publications

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“…A PPP lesion exhibits several unique characteristics, including vesicular involvement, erythema, lichenification, abnormal desquamation and pustule formation. We noted three distinct phases in pustule formation, which we term the vesicle, pustulovesicle (PV) and pustule phases . The pustules of a PPP lesion are generally thought to be aseptic because they are negative for bacterial cultures; therefore, PPP is not caused by bacterial infections.…”

Section: Introductionmentioning

confidence: 99%

The microbiome of the “sterile” pustules in palmoplantar pustulosis

Masuda-Kuroki

Murakami

Tokunaga

et al. 2018

Experimental Dermatology

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The skin microbiome influences skin pathophysiology. Palmoplantar pustulosis (PPP) is a chronic skin disease characterized by infectious‐like pustules on the palms and soles. These pustules are thought to be sterile because bacterial cultures obtained from the pustules are negative. However, culture methods are limited in their ability to identify all bacteria on the skin. We hypothesized that the “sterile” pustules of PPP do not lack bacteria, but rather contain a microbiome. To test this hypothesis, we identified bacteria in “sterile” pustules using non‐culture methods. We conducted Sanger and 16S rRNA sequencing using primers specific to the V1‐V2 region in PPP‐pustulovesicles (PVs) (n = 43) and pompholyx vesicle fluids (n = 15). Sanger sequencing identified some Staphylococcus, Propionibacterium, Streptococcus and Pyrinomonas species in PPP‐PVs but failed to identify any bacteria in most of the pompholyx vesicles. 16S rRNA sequencing of PPP‐PVs indicated the presence of a microbiome that included various phyla, including Firmicutes, Proteobacteria, Actinobacteria and Bacteroidetes. At the genus level, smokers had higher levels of Staphylococcus in PPP‐PVs compared with non‐smokers. These results indicate that a microbiome exists in “sterile” pustules of PPP and that PPP smokers had higher levels of Staphylococcus in pustules. It is therefore necessary to reconsider the pathogenesis of PPP from the perspective of the microbiome.

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Section: Introductionmentioning

confidence: 99%

The microbiome of the “sterile” pustules in palmoplantar pustulosis

Masuda-Kuroki

Murakami

Tokunaga

et al. 2018

Experimental Dermatology

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“…Such pustules form without passing through obvious stages of vesiculous evolution. However, as described above, PPP is classified into three phases: vesicle, pustulovesicle and pustule phases . Thus, pustules form after passing through phases of vesicular and pustulovesicular formation.…”

Section: Discussionmentioning

confidence: 99%

“…All patients had been diagnosed with PPP or pompholyx at the two institutions on the basis of their clinical features, histopathology and disease courses. Based on a previous report, PPP cases (Fig. a,b) were classified into three phases (vesicle, pustulovesicle and pustule) as shown in Figure .…”

Section: Methodsmentioning

confidence: 99%

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Diagnostic histopathological features distinguishing palmoplantar pustulosis from pompholyx

Masuda-Kuroki

Murakami

Kishibe

et al. 2019

The Journal of Dermatology

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Palmoplantar pustulosis (PPP) and pompholyx are both chronic and relapsing diseases occurring on the palms and soles. Although these two diseases have been considered completely different from each other, it is sometimes very difficult even for dermatologists to differentiate them from each other because of their similarities in clinical presentation. In this study, we aimed to analyze the histopathological features of PPP and pompholyx and find out “clues” to differentiate between PPP and pompholyx by their histopathological features. The histopathology of 11 PPP and six pompholyx patients, who were diagnosed with typical clinical history and histopathology, were carefully observed. PPP cases were divided into three phases (vesicle, pustulovesicule and pustule) and pompholyx cases were divided into two phases (vesicle and pustule), and histopathological findings and a 4‐point checklist to distinguish between PPP and pompholyx were preliminarily established. To confirm whether the checklist establishes the clues for diagnosis, biopsy samples from 43 patients (32 PPP and 11 pompholyx) who had been already diagnosed at five hospitals were examined according to our checklist without any additional clinical information. According to our 4‐point checklist, 31 of 32 PPP patients and all 11 pompholyx patients were diagnosed histopathologically consistent with their clinical diagnosis. In conclusion, histopathological findings of “vesicles without spongiosis” and “microabscess on the edges of vesicles” would be impact points for the differential diagnosis between PPP and pompholyx. The 4‐point checklist was trustworthy to distinguish between PPP and pompholyx.

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“…Palmoplantar pustulosis (PPP) patients show clinically sterile pustules, crusts and scales with erythemas on the palms and soles, and histopathologically intraepidermal vesicles filled with neutrophils . PPP may be caused by focal infections or metal allergy, and is considered to be related to pustular psoriasis or smoking habit …”

Section: Introductionmentioning

confidence: 99%

Effect of monochromatic excimer light on palmoplantar pustulosis: A clinical study performed in a private clinic by a dermatological specialist

Fumimori¹,

Tsuruta

Kawakami

et al. 2013

The Journal of Dermatology

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Palmoplantar pustulosis (PPP) is currently treated with various modalities, including excimer light, a form of ultraviolet lamp. This study reports effect of excimer light treatment in 34 Japanese PPP patients treated at a private clinic by one doctor, who was certified as a dermatological specialist by the Japanese Dermatological Association. The statistical analyses were performed upon a collaborative basis with faculties in universities. Disease response scores were determined by response to excimer light treatment. Scores of 1, 2, 3 or 4 were assigned to patients whose palmoplantar pustular psoriasis area and severity index (PPPASI) decreased to 25% or less, 25.1-50%, 50.1-75% or more than 75.1% of pretreatment PPPASI, respectively. In this study, 44.1% PPP cases had scores of 1 or 2, and considered good responders to excimer light treatment. There were no statistical differences between males and females, and between older (≥40 years) and younger groups (≤39 years) in terms of disease response score. Disease duration did not show any significant difference among these scores. Treatment times, total amount of ultraviolet and total treatment duration showed significant differences between score 1 and score 4 groups (P = 0.0164, =0.0137 and =0.0267, respectively). Particular interest was paid to smoking habits. Smoking in male patients was significantly higher than that in female patients (P = 0.0169). There was no statistical difference between smokers and non-smokers in terms of response to excimer light. In conclusion, this study suggested that excimer light is useful for both initial regimen and suppression of exacerbation in treatments of PPP.

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The Morphogenesis of Pustulosis Palmaris et Plantaris

Cited by 65 publications

References 10 publications

The microbiome of the “sterile” pustules in palmoplantar pustulosis

The microbiome of the “sterile” pustules in palmoplantar pustulosis

Diagnostic histopathological features distinguishing palmoplantar pustulosis from pompholyx

Effect of monochromatic excimer light on palmoplantar pustulosis: A clinical study performed in a private clinic by a dermatological specialist

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