When I was diagnosed with palmoplantar pustulosis, I was offered systemic treatment. I chose not to go down that route and instead began investigating the things I could change in my own life, food, stress, digestion, sleep, nutrient status and possible personal triggers.
That decision worked out extraordinarily well for me. Within a few months, the cycle of new pustules stopped, my skin healed and I eventually reached a remission that has lasted for more than fifteen years.
More than fifteen years later, I still believe that choosing to look first at the things I could change was the best decision I could have made for my own health.
When it is safe and realistic, I believe there is enormous value in starting with the foundations of health: food, stress, sleep, smoking where relevant, digestion, nutrient status and other personal triggers. These are not only about the skin. Improving them can benefit the whole body.
That does not mean medication has no place. PPP can be brutal. It can make walking painful, interfere with work and sleep, and wear you down mentally. Medical treatment can be important when symptoms are severe, when lifestyle changes are not enough, or when you simply need more help to get the disease under control.
I wanted to understand why my PPP was active.
When I was ill, I did not feel satisfied with only asking, “What can I put on my skin?” I wanted to know what was happening underneath the surface and whether anything in my wider health or daily life was helping to keep the disease active.
That question changed everything for me. Instead of seeing my skin as an isolated problem, I began looking at my body as a whole.
I began researching and experimenting. I changed several things at the same time, which means I cannot scientifically isolate one single factor and say, “this cured me.” What I can say is that the overall pattern changed.
I simplified my diet, removed foods I suspected were affecting me, paid much more attention to stress, worked on digestive health and sleep, and became far more observant of what happened before a flare.
My strongest personal dietary trigger turned out to be gluten. Stress was, and still is, the trigger I respect most.
This is the message I want people with PPP to hear: there are things you can change. There are triggers you can identify. And those changes can make an extraordinary difference. My own remission is proof of what became possible in my body, even though every person's path will be different.
Where biologics fit into the picture.
Biologic medicines target specific parts of the immune system involved in inflammation. That is different from simply describing them as medicines that “suppress the immune system.” Different biologics target different inflammatory pathways, and their benefits and risks are not identical.
PPP is also important to separate from ordinary plaque psoriasis. Treatments that work extremely well for plaque psoriasis do not necessarily work as reliably for palmoplantar pustulosis.
More recent controlled trials and reviews have found meaningful improvement in some people with PPP from certain targeted systemic treatments. Guselkumab has some of the strongest trial evidence, while studies have also reported benefit with treatments including brodalumab, risankizumab and apremilast. Availability and approval vary by country.
There is also a genuine paradox in this area: TNF-alpha inhibitors used to treat other inflammatory diseases can occasionally trigger palmoplantar pustulosis or a similar pustular eruption in some people.
So I would no longer write, as I did in the older version of this article, that biologics are simply “rapid relief with immune suppression” while natural approaches are “long-term wellness with no side effects.” The reality is much more nuanced than that.
Medical treatment has clinical-trial evidence. My lifestyle approach has a different kind of evidence.
Medical treatments
Prescription treatments can be tested in controlled trials, where researchers can compare outcomes between groups and measure adverse effects. That gives us evidence about average treatment effects across patients.
My remission
I know exactly what happened in my own body and what changed before my disease became inactive. That experience matters, but it cannot tell us how often the same approach would work in a larger group of people.
This is why I do not think the two should be treated as competing forms of evidence. They answer different questions.
Clinical research can tell us whether a treatment has helped groups of patients under controlled conditions. Personal experience can sometimes reveal patterns worth investigating, especially in a condition where triggers and treatment responses vary so much, but it does not replace controlled evidence.
For me, it meant working with my health before escalating treatment.
Natural healing was not about doing nothing. It was active, deliberate and at times demanding. I changed the conditions around my health and looked systematically for the things that could be keeping my body under pressure.
When it is medically safe to do so, I still believe this is an incredibly valuable place to start. It can improve far more than the appearance of your skin because the same foundations support your health as a whole.
For me, that meant:
- identifying foods that seemed to affect my symptoms
- reducing refined and highly processed foods
- taking stress and recovery much more seriously
- paying attention to sleep and digestive health
- looking for nutritional deficiencies rather than taking supplements blindly
- tracking patterns instead of treating each flare as an isolated event
- using appropriate skin care and symptom relief while my skin healed
For somebody who smokes, stopping smoking is also one of the clearest evidence-based lifestyle changes to discuss in PPP. Smoking is one of the strongest known risk factors for the condition.
Would I make the same choice again?
Yes, for myself, knowing what I know now, I would.
I was fortunate. My disease responded quickly once I changed the wider pattern of my life. Within roughly three months, new outbreaks stopped. I did not need to progress to biologic treatment, and more than fifteen years later I remain free from a significant PPP flare.
I would also give the approach enough time to see whether the overall pattern was changing, while staying alert to signs that I needed more medical help. Natural healing should never mean ignoring severe or rapidly worsening disease.
The goal is not to prove that one philosophy of treatment is right. The goal is to get your life back.
That is probably the biggest change in how I would frame this article today.
Why I still choose to start with the foundations of health.
| Question | Biologics / targeted treatment | Lifestyle and trigger investigation |
|---|---|---|
| Evidence | Some treatments have controlled clinical-trial evidence in PPP. | No single lifestyle protocol has been proven to put PPP into remission. |
| Response | Can produce meaningful improvement in some patients, but PPP response is variable. | Highly individual. Some people report strong personal patterns; others do not. |
| Risks | Depend on the specific medicine and can include infections or other adverse effects requiring monitoring. | Usually lower-risk when changes are sensible, but restrictive diets and supplements can still cause harm. |
| Speed | Some treatments can improve symptoms within weeks or months. | Changes can take time, and there is no predictable response timeline. |
| Wider health | Designed to target specific inflammatory pathways rather than improve lifestyle or general health. | Can also improve nutrition, sleep, stress resilience, metabolic health and other aspects of wellbeing. |
| Can they coexist? | Yes. You can work on the foundations of health while also using medical treatment when it is needed. | |
Questions I think are more useful than “natural or medical?”
I still believe deeply in looking for your own patterns.
Nothing about updating this article changes what I experienced.
I went from painful PPP that made walking difficult to long-term remission. Changing my diet and lifestyle was central to that journey. It changed my life, and it is the reason this website exists.
I still believe people deserve to be curious about their own bodies. I still believe stress, food, sleep, smoking, infections, medications and other individual factors are worth paying attention to. And I still believe that being told a disease is “chronic” should not automatically be interpreted as “you will feel like this forever.”
So where do I stand today? I still believe that, when it is safe to do so, starting with the foundations of health is the best first step. Look at what you eat. Look at stress. Look at sleep. If you smoke, seek help to stop. Look at infections, medicines, nutrient deficiencies and the patterns around your flares. Give your body every reasonable advantage you can.
Medication can still have an important role. But it does not have to be the only tool in the box, and it does not have to stop you from asking why your disease is active or what else you can change.
PPP is called a chronic disease, but chronic does not mean powerless. There are things you can change. There are patterns you can uncover. And meaningful, long-lasting remission can be possible. I know that because I have lived it for more than fifteen years.
Continue from here.
Sources used for this 2026 update.
- British Association of Dermatologists. Palmoplantar pustulosis, patient information. Read the clinical guidance.
- Heidemeyer K, et al. Palmoplantar Pustulosis: A Systematic Review of Risk Factors and Therapies. Read the systematic review.
- Branyiczky MK, et al. A systematic review of recent randomized controlled trials for palmoplantar pustulosis. View the review.
- Alshareef KM, et al. Comparative efficacy of systemic treatments for palmoplantar pustulosis: a systematic review and network meta-analysis. View the analysis.
- Mössner R, et al. Palmoplantar pustulosis: pathogenesis, differential diagnosis and treatment. Read the 2026 review.
