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PPP(Palmoplantar pustulosis)

PPP is a chronic disease which is a type of inflammatory keratosis. This is characterized by repeated eruption of small pustules on the palm or the sole. Patients sometimes experience a thickening of the skin.

Cause of the disease

It is not clearly elucidated. However the following factors are closely related to the onset of the disease.

  1. Chronic infection (at the teeth, tonsil, sinus, gall bladder, …etc.)
  2. Metal allergy (especially metals used for dental inlays)
  3. Others (autonomic imbalance theory)


When we suspect the possible focus of infection, we do a blood test and/or identification of the bacteria on the tonsils or other areas if possible. If a metal allergy is suspected, we do a patch test for metals. (Please refer to a separate page.) In addition, we sometimes check the skin for a possible fungal infection for differential diagnosis.


Ointments are used for the pertinent skin lesion. A strong steroid should be applied to the skin, possibly frequently on the palm. Using cotton gloves is helpful to cover the lesion to strengthen the effect of the ointment. Oral anti-histamine is used against the itchiness. Sometimes oral antibiotics are used as well. If a background infection or metal allergy is suspected, treatments against these conditions can be applied as well. In these cases, the tonsils may be removed, or dentists are used to remove and replace the dental inlays and/or to treat periodontal diseases.