Despite, the fact that palmoplantar pustulosis is still widely known by this name, it is currently regarded as a disease distinct from psoriasis. The real cause is still unknown. Septic foci have been blamed, but their removal may not cure eruptions. A case series of
Topical corticosteroids under occlusion are the first-line therapy. Prolonged therapy is needed on a second or third-day basis, in order to sustain the obtained effects. Oral retinoids in combination with oral PUVA are the best second-line therapy. No difference in the efficacy between etretinate and acitretin was found. The disadvantage of systemic retinoid therapy is its teratogenicity. Oral PUVA is effective and the response is enhanced by combination with retinoids. There is an established increased efficacy of a combination of retinoids with PUVA therapy over each treatment modallity when used alone. Liarozole may be an effective and well-tolerated therapy, but side effects are like in retinoids. The advantage over acitretin is that raised levels of retinoic acid fall to normal within a few days after cessation of therapy. Significant improvement, but no complete clearance, occurs in most patients treated with low dose cyclosporine. Before starting the treatment, it is necessary to consider: patient’s individual factors, since many patients have already received some previous treatment; specific treatment factors such as formulation, way of administration, dose, different drug combinations; regimens and periods of treatment; site of involvement, due to differences between hands and feet in the probability of response to treatment.