PPP can get inside your head as well as under your skin.
Pain. Itching. Burning. Not being able to walk properly. Hiding your hands. Cancelling plans. Wondering whether the next treatment will work. Trying to explain a rare disease to people who have never heard of it.
It is not difficult to understand why PPP can affect your mood. For me, one of the hardest parts was feeling that nobody around me truly understood what I was going through.
If PPP has made you feel low, anxious, angry, isolated or frightened about the future, you are far from the only person who has felt that way.
Research now reflects what many people with PPP have been saying for years.
A large study using health insurance claims and electronic health records in the United States and Japan found both anxiety and depressive disorders among people with PPP. The recorded rates varied substantially between databases and countries, which means there is no single percentage that describes every PPP population.
Seen across PPP populations
In the 2023 US and Japanese database study, depressive disorders were documented in 5.7% of the Japanese PPP cohort and in roughly 12% to 36% across the different US datasets. Anxiety showed a similarly wide range. These data show association, not that PPP caused every case.
PPP can affect everyday health profoundly
A 2024 Swedish register study of 306 people with PPP found a substantial negative effect on health-related quality of life. On a general health measure, the PPP group scored worse than patients with plaque psoriasis after adjustment for potential confounding factors.
An older controlled study also found moderate-to-severe anxiety to be significantly higher among patients with PPP than matched controls, adding to the evidence that psychological stress and PPP can interact.
It is rarely just one thing.
Pain wears you down
Constant burning, itching and painful fissures can affect sleep, concentration and patience. It is difficult to feel emotionally strong when your body is hurting day after day.
PPP takes away ordinary things
Walking to the shop, cooking, holding a pen, exercising, wearing certain shoes, showering or simply standing can become difficult. Losing normal independence can have a huge emotional impact.
The disease is visible
Hands are difficult to hide. People can stare, ask questions or assume a pustular condition is contagious. That can make social situations uncomfortable even when you know you have done nothing wrong.
It can feel incredibly lonely
PPP is rare enough that many people do not know anyone else with the disease in real life. Friends and family can care deeply and still not understand what the pain, uncertainty and frustration actually feel like.
Treatment uncertainty is exhausting
Trying treatment after treatment without knowing what will work can create a sense of powerlessness. For me, beginning to understand my own patterns helped replace some of that helplessness with direction.
Being dismissed hurts too
When the severity of PPP is judged by the small percentage of skin involved, patients can feel that the true impact is being underestimated. Hands and feet may represent little body surface area while affecting almost every part of daily life.
The loneliness was almost as difficult as the skin.
When my PPP was active, I did not know anybody else with it. People around me could see that my hands and feet were bad, but they could not really understand what it was like to live inside the condition.
I wrote in the original version of this article that I had started to feel quite depressed dealing with the disease and the lack of understanding around me. What I needed most at that stage was not somebody telling me to cheer up. I needed to feel understood and to know that somebody else had been where I was.
Finding other people with PPP changed that completely.
Find people who do not need PPP explained to them.
Years ago I found an online patient forum and suddenly realised there were other people describing exactly the things I was experiencing. That was enormously comforting.
Later, our own global PPP support community grew into a place where people from different countries could compare experiences, ask the questions that are difficult to answer elsewhere and simply say, “I am having a terrible day,” to people who understand why.
Support does not mean everybody has to choose the same treatment.
Some members focus heavily on diet and lifestyle. Others use biologics or other medical treatments. Many combine different approaches. The value of community is not that everybody agrees. It is that you no longer have to experience PPP in isolation.
Mental wellbeing improved when I stopped feeling completely powerless.
I found my people
The moment I could talk to people who knew exactly what a PPP flare felt like, the disease became less lonely.
I gave myself a plan
Learning about possible triggers and making changes to my diet, stress and lifestyle gave me something constructive to do instead of waiting passively for the next flare.
I stopped treating stress as irrelevant
Stress became one of my clearest personal PPP patterns. Working on it helped both the way I felt emotionally and the way I approached my physical recovery.
I learned that a flare was not my whole future
When you are in the middle of a severe flare, it is very easy to believe life will always look like that. My own long-term remission eventually taught me otherwise.
I still believe in supporting the foundations naturally.
Sleep, nourishing food, movement when your feet allow it, less alcohol, stopping smoking, time outdoors, meaningful connection and reducing chronic stress are not small things. They support health far beyond PPP and were important parts of my own recovery.
Nutritional deficiencies can also affect how a person feels, and it can be sensible to investigate them when symptoms or medical history suggest a problem. But I would no longer tell somebody with depression that one vitamin combination is the missing answer.
Natural foundations are valuable. Persistent depression deserves to be taken seriously in its own right.
You do not have to wait until you are at breaking point to ask for help.
There is a difference between having a terrible day because your skin hurts and experiencing persistent depression. Current clinical guidance advises seeking help when depressive symptoms are present for most of the day, nearly every day, for around two weeks or more, particularly when they affect everyday life.
Signs worth taking seriously include:
- feeling persistently low, empty or hopeless
- losing interest in things you normally enjoy
- withdrawing from people around you
- major changes in sleep, appetite or energy
- difficulty concentrating or functioning normally
- thoughts of self-harm, suicide or that life is not worth living
Depression can be treated. Depending on severity and individual circumstances, treatment can include guided self-help, psychological therapies and medication. Having PPP does not make you less deserving of proper mental-health care.
If you are thinking about harming yourself or feel that you may not be safe, seek urgent professional help now. Contact emergency or crisis healthcare where you live, or tell somebody you trust and ask them to stay with you while you get help.
Sometimes you have to explain the impact, not just the rash.
PPP can look relatively small to someone who sees only the percentage of skin involved. If you need support from family, friends, an employer or a doctor, it can help to describe what the disease actually prevents you from doing.
“PPP is not only a rash on my hands and feet. The pain affects how I walk, sleep, work and use my hands. I am also finding the uncertainty and constant symptoms emotionally difficult, and I need support with that part too.”
One of the most powerful things another person with PPP can give you is the sentence: “I know exactly what you mean.”
PPP, depression and mental health FAQ.
Is depression common in people with palmoplantar pustulosis?
Depressive disorders and anxiety have been documented in PPP populations, although reported rates vary substantially between studies, countries and healthcare databases. PPP also has a well-documented negative impact on quality of life.
Can stress make PPP worse?
Stress has been reported as an aggravating factor in PPP, and an early controlled study found significantly higher anxiety among PPP patients than matched controls. Stress was also one of the clearest flare patterns in my own experience.
Can improving my PPP improve my mental health?
It can remove some of the burdens that contribute to distress, such as pain, loss of function, embarrassment and uncertainty. But depression can also need its own treatment, so persistent symptoms should not simply be assumed to disappear when the skin improves.
Can diet or vitamins treat depression caused by PPP?
A nourishing diet and correcting genuine nutritional deficiencies are worthwhile parts of overall health, but I would not treat persistent depression as simply a vitamin problem. Depression deserves appropriate assessment and support.
Where can I talk to other people with PPP?
Well-Healed has a dedicated PPP support page and a global Facebook community where people with PPP share experiences, questions and practical support.
Hope became easier when I had something practical to work toward.
How to Treat Palmoplantar Pustulosis Naturally grew out of the period when I was trying to understand my own triggers and regain some control over my health.
It covers the diet and lifestyle framework I used, but also the stress, frustration and emotional side of trying to live with a chronic condition while searching for a path toward remission.
More support for the difficult days.
Sources used for the 2026 update.
- Ramcharran D, et al. The Epidemiology of Palmoplantar Pustulosis: An Analysis of Multiple Health Insurance Claims and Electronic Health Records Databases. Read the 2023 PPP study.
- Norlin JM, Löfvendahl S, Schmitt-Egenolf M. Health-related quality of life in patients with palmoplantar pustulosis: a Swedish register study. View the 2024 Swedish study.
- Sáez-Rodríguez M, et al. The role of psychological factors in palmoplantar pustulosis. View the anxiety and stress study.
- Trattner H, et al. Quality of life and comorbidities in palmoplantar pustulosis: a cross-sectional study on 102 patients. View the PPP quality-of-life study.
- National Institute for Health and Care Excellence. Depression in adults: treatment and management. Read the NICE guideline.
