At 26, Sophie felt as though PPP had taken over her entire life.
She could not walk normally. She struggled to use her hands. Sleeping, showering and working became difficult, and repeated infections led to hospital treatment.
When Sophie first contacted me in January 2019, she had already been living with severe palmoplantar pustulosis for almost two years. She had tried several treatments and felt she was running out of options.
This was not a mild skin problem.
Sophie told me that the disease had spread across her hands and feet and involved her nails. She had also developed psoriasis elsewhere on her body. Her dermatologist described her case as exceptionally severe.
Hands and feet
Deep cracks and painful skin made walking and using her hands extremely difficult. Even showering became painful.
Work and daily life
She became unable to work normally because she could not walk properly or reliably use her hands.
Infections
She reported repeated infections and several hospital visits. In January 2019, a serious infection in her hand and arm required surgery to drain the infection and intravenous antibiotics.
Mental health
The relentless pain, sleep loss and loss of independence affected her mental health profoundly. Sophie later wrote openly about reaching an extremely dark point before finding the determination to keep going.
Instead of choosing between treatment and lifestyle, Sophie did both.
Sophie had already tried biologic treatments without getting the result she desperately wanted. In early 2019 her dermatologist wanted her to continue with another biologic that had recently become available to her. The drug linked in the original article was secukinumab, sold as Cosentyx.
At the same time, Sophie wanted to work on the things she could change herself. With support from her mother she changed the way she ate, stopped smoking, reduced habits she felt were working against her and began taking her general health much more seriously.
This is one of the reasons I still value Sophie's story. Her improvement cannot honestly be attributed to one single thing. Medication and lifestyle change happened alongside each other.
Within weeks, Sophie began getting her life back.
By February 20, 2019, Sophie told me her skin was not yet perfect but was dramatically better than it had been. Most importantly, she could walk normally again.
When she sent me her longer update in March, she reported that her skin had been in remission for roughly seven weeks. She was deeply grateful to her dermatologist, to the people who had supported her and to herself for continuing when things had felt unbearable.
Sophie's message to other people living with severe disease was simple: do not lose sight of hope.
The latest update published here brought another important development.
On December 3, 2020, I added an update saying that Sophie had stopped biologic treatment and had remained free of PPP symptoms for the previous three months. At that time she was more or less following an AIP-style diet.
That is the latest outcome documented in this article. I therefore do not want to turn Sophie's experience into a claim of permanent cure or assume what happened in the years that followed. What we can say is that, at the time of her last published update, she was doing remarkably well.
What I would explain differently today.
The original 2019 article described biologics as medications that simply weaken the immune system. That is too broad. Modern biologic drugs are designed to target specific parts of immune signalling. Secukinumab, for example, targets the inflammatory cytokine IL-17A.
That targeted action does not mean the drugs are free from risk. Current prescribing information for secukinumab includes a warning about infections, including serious infections, and clinicians are advised to use caution in people with chronic or recurrent infections.
Secukinumab has also been studied specifically in moderate-to-severe PPP. In the 2PRECISE trial the primary endpoint was not met at week 16, although the higher-dose group showed more PPPASI75 responses than placebo and some patients continued to improve during longer treatment.
Sophie's story shows why this does not have to be an ideological choice. A person can use medication when it is needed and still work on smoking, food, stress, sleep and other foundations of health at the same time.
Sophie's recovery was about much more than clear skin.
She stopped smoking
This is particularly important in PPP because smoking is one of the strongest modifiable factors repeatedly associated with the disease.
She changed how she ate
She moved toward a nutrient-dense diet and later reported following the AIP approach to a large extent. That was part of her personal strategy, not proof of one universal PPP diet.
She worked on stress
Stress had been a major feature of Sophie's life. Her experience reinforced something I had also seen in myself: recovery can require changing the environment around the body as well as what we put into it.
She accepted medical help when she needed it
Her serious infection required surgery and intravenous antibiotics. Her dermatologist also continued working with her through treatment decisions. Natural healing and appropriate medical care do not have to be enemies.
The most powerful part of Sophie's story is not that she found one perfect treatment. It is that she kept going long enough to find a combination that gave her life back.
You do not have to choose between learning about your body and getting medical help.
My own path to long-term remission was built around identifying triggers and strengthening the foundations of my health. My original PPP book explains the framework I used, while my newer articles also discuss how I think about medical treatment and lifestyle today.
Continue from here.
Sources used for this 2026 update.
- Mrowietz U, et al. Secukinumab for moderate-to-severe palmoplantar pustular psoriasis: results of the 2PRECISE study. View the clinical trial.
- Heidemeyer K, et al. Palmoplantar Pustulosis: A Systematic Review of Risk Factors and Therapies. Read the systematic review.
- U.S. Food and Drug Administration. COSENTYX (secukinumab) prescribing information. View prescribing information.
