Health condition
Palmoplantar pustulosis
Palmoplantar pustulosis causes recurring crops of sterile yellow pustules on the palms and soles that dry to brown scaly patches; it is strongly linked to smoking, is stubborn to treat, and can be disabling for hands-on work and walking.
Why trust this guide
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Editorial team
Written by our editorial team from the UK sources listed on each page.
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Sourced from guidance
Checked against current NHS and UK specialist society guidance at the time of review.
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Current for 2026
Reviewed on 2026-09-27 with the next review scheduled for 2027-09-27.
Key facts
The essentials at a glance.
The symptoms to recognise, when to seek help, which specialist to see, and what treatment usually involves.
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Crops of deep-seated yellow pustules on palms and soles maturing to brown, scaly, cracked patches - typically both painful and itchy
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Over 90% of those affected are current or former smokers; the condition mainly affects middle-aged women
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Related to psoriasis but behaves distinctly; check for associated bone and joint pain (SAPHO syndrome)
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Treatment ladder: super-potent topical steroids under occlusion, acitretin, PUVA phototherapy, methotrexate and biologics for resistant disease
Understanding the condition
What it is and what happens next.
What causes it, how it is diagnosed, and the treatment routes available in the UK.
What it is and how it feels
Because the pustules sit deep in the thick skin of palms and soles, they feel like tender grains under the surface before drying into brown spots and painful fissures. Gripping tools, typing and simply walking can hurt, and the visibility of the hands means the condition carries a social weight that outsiders rarely appreciate; smoking cessation genuinely improves outcomes even though the disease may not vanish.
Diagnosis and treatment routes
Diagnosis is clinical, with mycology samples to exclude fungal infection and questions about sternum, collarbone or joint pain that would point to SAPHO syndrome. Treatment starts with ultrapotent steroids under cling-film occlusion and coal-tar or vitamin D analogues; systemic acitretin suits many patients, hand-and-foot PUVA is effective, and biologic therapy is an option when quality of life remains poor. In much of the UK, a routine NHS referral to the relevant specialist clinic can take several months, whereas an initial appointment with a private consultant is typically available within around two weeks.
Seeing a specialist
Who to see, and how quickly you can be seen.
The specialist for this condition is usually a consultant dermatologist. Your GP can refer you on the NHS, or you can arrange a private consultation directly.
A quiet reminder
This guide is for information, not medical advice.
Your GP knows your history and can tell you which parts apply to you. If in doubt, see them - and seek urgent care for any of the emergency symptoms described above.
Frequently asked
Common questions about Palmoplantar pustulosis.
Quick, plain-English answers to what people ask us most.
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What is Palmoplantar pustulosis?
Palmoplantar pustulosis is a recognised medical condition that affects the body in ways specific to its underlying cause. Getting an accurate diagnosis is the first step towards understanding your options and what to expect.
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What causes Palmoplantar pustulosis?
The underlying cause can involve a mix of genetic, environmental, and lifestyle factors, and in some cases no single clear cause is identified. Your doctor can help clarify which factors are most relevant to your case based on your history and any test results.
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What are the symptoms of palmoplantar pustulosis?
Symptoms can vary from mild to significant and often develop gradually, though some people notice a more sudden onset. Because symptoms overlap with other conditions, a proper clinical assessment is important for an accurate diagnosis.
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Is palmoplantar pustulosis serious or dangerous?
Most cases are manageable with appropriate treatment, though severity varies from person to person. Left unaddressed, some cases can lead to complications, so getting an assessment rather than waiting is generally the safer approach.
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Is palmoplantar pustulosis hereditary or genetic?
Some cases have a genetic component that runs in families, while others develop without any inherited link, arising instead from environmental or lifestyle factors. If you have a strong family history, mentioning this to your doctor can help guide whether genetic assessment is worthwhile.
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How is palmoplantar pustulosis treated?
Treatment approaches vary depending on severity and individual circumstances, and may include lifestyle changes, medication, or referral to a specialist for more targeted therapy. Your GP or specialist will tailor a plan based on your specific situation.
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How long does palmoplantar pustulosis last?
Duration varies — some cases are short-lived and resolve fully with treatment, while others are longer-term or chronic conditions managed over time. Your doctor can give you a more specific expectation once they understand your individual case.
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When is surgery or specialist treatment needed?
Specialist or surgical treatment is usually considered when simpler treatments haven't controlled symptoms adequately, or when the condition is affecting quality of life or function significantly. A specialist assessment can clarify whether this applies to your situation.
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When should I see a doctor about palmoplantar pustulosis?
See a doctor if symptoms are new, worsening, or affecting your daily life. On the NHS, routine referrals to a specialist can take 20 to 45 weeks or longer depending on your area; with private healthcare you can typically see a consultant within about 2 weeks, which can be worthwhile if you want a faster diagnosis or reassurance.
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Can lifestyle changes help manage palmoplantar pustulosis?
Alongside medical treatment, factors such as a balanced diet, regular appropriate exercise, stopping smoking, and managing stress can support recovery and reduce the risk of the condition worsening or recurring. Your healthcare team can advise which lifestyle changes are most relevant to your specific condition.