Palmoplantar pustulosis (PPP) is a chronic relapsing inflammatory dermatosis showing pustular eruption localized to palm and sole. Data regarding general characteristics and comorbidities of PPP are scarce.
We conducted a retrospective review of 262 patients with PPP at Severance hospital between January 1, 2006, and December 31, 2017 to analyze the clinical features, etiologic factors, treatment, and comorbidities of PPP. 
Of 262 patients with PPP identified, 150 (57.3%) were female, and the mean age at onset was 46.3 years. More than a half of patients (n=167, 63.7%) were current or former smokers. At diagnosis, 91 patients (35.1%) showed nail involvement and 39 (14.9%) showed arthralgia. And 64 patients(24.4%) showed other area involvement. Comorbid conditions included hypertension in 55 patients (20.9%), type 2 diabetes mellitus in 46 (17.5%), and thyroid disease in 32 (12.2%). In all, 253 patients (96%) received topical corticosteroids, 45 (17.1%) received phototherapy, and 140 (53.4%) received systemic agents. In multivariate logistic regression analysis, palmoplantar distribution, nail involvement, and smoking history were statistically significant predicting factors for the use of systemic treatment. Nail involvement, joint symptom, smoking history, and thyroid disease were significant predicting factors for more recalcitrant disease represented as cases treated with more than 2 systemic therapies.
In conclusion, more than half of the patients in this study had a history of smoking, which was found to be a significant predicting determinant for more refractory course of the disease. Patients with PPP frequently presented some comorbid conditions including hypertension, type 2 diabetes mellitus, and thyroid diseases. Given this associated factors and comorbidities, thorough history taking and proper patient-education are necessary for the comprehensive care of patients with PPP.

Clinical features, etiologic factors, treatment, and comorbidities of palmoplantar pustulosis: a retrospective single-center study