Palmoplantar Pustulosis and Allergies: A Systematic Review

Alexandra M.G. Brunasso Vernetti; Matteo Puntoni; Cesare Massone

doi:10.5826/dpc.0902a05

Palmoplantar Pustulosis and Allergies: A Systematic Review

Authors

Alexandra M.G. Brunasso Vernetti Department of Dermatology, Galliera Hospital, Genoa, Italy
Matteo Puntoni Unit of Biostatistics, Scientific Directorate, Galliera Hospital, Genoa, Italy
Cesare Massone Department of Dermatology, Galliera Hospital, Genoa, Italy

Keywords:

palmar plantar pustulosis, contact allergy, psoriasis, metals, nickel, patch test

Abstract

Background: In 2007 the International Psoriasis Council considered palmoplantar pustulosis (PPP) a condition separate from psoriasis, and several authors maintain that PPP is a reactive process to metal contact allergies independent from psoriasis.

Objectives: To evaluate the frequency of allergies and psoriasis in patients with PPP and to determine the role of allergens in PPP.

Methods: A systematic search of the English databases (PubMed and Web of Science) from January 1964 to August 2018 to identify all patients affected by PPP and allergies and/or psoriasis.

Results: In total, 16 publications describing a total of 519 patients with PPP were evaluated and 122 cases of concomitant PPP and metal allergy were found. The frequency of allergies among patients with PPP was 22.7%; between the identified allergens, 84.3% of cases correspond to metal allergies. In 65.1% of metal allergies, an improvement in PPP was seen after withdrawal of contact. The concomitant presence of psoriasis was recorded in 18% of the cases.

Conclusion: There is some evidence to support the association of PPP with metal allergies but also with psoriasis, suggesting the role of metal allergens as a trigger factor in patients with PPP.

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