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Heavy smoking (>20 cigarettes/day)
Seasonal factors (high humidity and
high temperature)


in waves  Skin Lesions  Pustules in stages of evolution 2–5 mm  Deep-seated. burning → itching  Eruptions come and go. yellow develop into duskyred macules and crusts  Present in areas of erythema and scaling or normal skin .CLINICAL FEATURES  Symptoms  Stinging.

and insteps • acral portions of the fingers and toes . may be only a localized patch on the sole or hand • Or involve both hands and feet with a predilection of thenar and hypothenar flexor aspects of fingers.• Location • Limited to palms and soles. • heels.

Groups of pustules measuring 2 to 4 mm in diameter occur on erythemathous skin on pamls and soles. Both feet and both hands are normally affected symmetrically but can also be found on one side only .

walk or do manual work may greatly reduce the quality of life . As pustules become older. their yellow color changes to dark brown  In untreated PPP . pain and the inability to stand. the lesions show various shades of color  Dried pustules are shed within approximately 8 to 10 days  In severe eruptions .

Lession may occasionally spread beyond the predilection sites. Within several days after pustules formation. lesions dry. and pustules may appear on the wrists. May be followed by ezcematous changes with scaling and fissuring . flatten. and acquire a brownish color.

Pustules are sterile and pruritic. and when they get larger. become painful.Pustules that are partially confluent on the palm of a 28-year-old female. .


HISTOPATOLOGY Histologically. there is a spongioform pustule and a moderate lymphohistiocytic infiltrate .

most commonly on the dominant hand • Usually associated with tinea pedis .DIFFERENTIAL DIAGNOSIS TINEA MANUM • Chronic dermatophytosis of the hand(s) • Often unilateral.

inflammatory dermatitis • Occurring in the form of coin-shaped plaques composed of grouped small papules and vesicles on an erythematous base . pruritic.DERMATITIS NUMMULAR • Nummular eczema is a chronic.

CONTACT DERMATITIS Irritant contact dermatitis (ICD) is caused by a chemical irritant. Allergic contact dermatitis (ACD) by an antigen (allergen) that elicits hypersensitivity reaction. .

TREATMENT Fitz’s Patrick .

The disease is commonly resistant to treatment  Acitretin is generally extremely effective at a dose of 0. but it is not suitable for long-term treatment. Andrew’s Disease of The Skin .5-1 mg/kg/day. although rebound occurs more quickly than with etretinate  Low-dose cyclosporine in doses ranging from 1.25 to 5 mg/kg/day has also been very effective.

In phases of remission fewer pustules are produced but the skin may remain erythematous hyperkeratotic. sometimes resembling eczema. In patient with active disease of fresh pustules at the beginning of treatment relapse within a few days after cessation of any therapy or dose-reduction is highly likely.PROGNOSIS The clinical course of PPP is highly unpredictable. .