Helpful Clinical Features for Differential Diagnosis of Palmoplantar Pustulosis and Pompholyx

Jang, Sihyeok; Kim, Min Woo; Park, Hyun Sun; Yoon, Hyun Sun; Cho, Soyun

Abstract

BACKGROUND
Palmoplantar pustulosis (PPP) and pompholyx are both chronic vesiculopustular conditions of the palms and soles. Because both share similar clinical and histological features, it is difficult even for dermatologists to differentiate between these two diseases.
OBJECTIVE
To analyze clinical features that can be helpful in differentiating the two diseases.
METHODS
The clinical history of 133 patients with vesicles or pustules on the palms and/or soles was evaluated. Patients were divided into a PPP group and a pompholyx group.
RESULTS
There was no sex or age predilection in either group and no significant difference in overall localization and symmetry of lesions. Bilaterality was found in 75.0% of cases of PPP and 82.0% of cases of pompholyx. More lesions were found on the tip of the finger/toe, and the side of the toe in the pompholyx group than in the PPP group. However, there was no difference between two groups in lesions on the sides of fingers. More cases of PPP involved right distal interphalangeal (DIP) and bilateral proximal interphalangeal (PIP) joint areas compared with pompholyx. There were more smokers in the PPP group. Among several comorbidities, only atopic dermatitis and nummular eczema were associated with pompholyx.
CONCLUSION
Several characteristics of patients and clinical findings may serve as useful "clues" to differentiate between and determine treatment for PPP and pompholyx.