Clear answers to 20 common PPP questions.
Living with palmoplantar pustulosis can be painful, frustrating, and confusing, especially when reliable information is difficult to find.
This page brings together the questions I am asked most often about symptoms, diagnosis, treatment, triggers, diet, remission, supplements, stress, gut health, and finding appropriate medical support.
Written by Åsa Kärrman · Patient advocate and author · Last updated August 11, 2026
Understanding PPP, its symptoms, and diagnosis.
01 What is palmoplantar pustulosis?
Palmoplantar pustulosis, usually shortened to PPP, is a rare, long-lasting inflammatory skin condition. It causes repeated crops of sterile pustules on the palms of the hands and the soles of the feet. “Sterile” means that the pus is not caused by a bacterial infection.
PPP is closely related to pustular psoriasis, although specialists do not always classify the relationship in exactly the same way.
If you are wondering how uncommon the condition actually is, read How Rare Is Palmoplantar Pustulosis?
02 What causes palmoplantar pustulosis?
The exact cause is not fully understood. PPP involves abnormal inflammatory activity in the skin, and several factors may contribute. Smoking has a particularly strong association with PPP. Genetics, infections, stress, and certain medications may also be relevant for some people.
Having a possible risk factor does not mean that it is the only cause of the condition.
03 Is palmoplantar pustulosis contagious?
No. PPP is not contagious. You cannot catch it from another person or pass it on through touching, sharing objects, or ordinary close contact.
The pustules are normally sterile, although cracked skin can sometimes develop a separate secondary infection that may need medical attention.
04 What are the symptoms of palmoplantar pustulosis?
Typical symptoms include small pus-filled pustules, red or inflamed skin, scaling, peeling, itching, burning, tenderness, and painful cracks. The pustules may turn brown as they dry.
Because PPP affects the hands and feet, even a limited area of skin can have a major effect on walking, working, sleeping, and everyday tasks.
05 How is palmoplantar pustulosis diagnosed?
Diagnosis is usually made by a dermatologist using the appearance and location of the skin changes together with your medical history.
Tests may sometimes be needed to rule out fungal or bacterial infection, eczema, contact dermatitis, or other pustular skin conditions. In unclear cases, a skin biopsy may be considered.
Because PPP can resemble several other conditions, diagnosis is sometimes delayed. I describe my own experience in Why Is Palmoplantar Pustulosis So Difficult to Diagnose?
Treatment, possible triggers, and the possibility of remission.
06 Can palmoplantar pustulosis be cured?
PPP is generally considered a chronic condition, and there is no treatment that can guarantee a permanent cure for everyone.
However, symptoms can improve, and some people experience long periods of remission. The most useful approach may involve medical treatment, avoiding known triggers, protecting the skin, and supporting overall health.
07 How is palmoplantar pustulosis treated?
Treatment depends on severity, other health conditions, and what has already been tried. Options may include strong topical corticosteroids, moisturisers, phototherapy, oral retinoids, other systemic medicines, and immune-modulating treatments.
PPP can be difficult to treat, and some medicines are used differently depending on the country and the individual situation. A dermatologist should help you weigh expected benefits, risks, and monitoring requirements.
08 What can trigger palmoplantar pustulosis flare-ups?
Possible triggers and aggravating factors include smoking, emotional stress, infections, skin irritation, and certain medicines. Alcohol, sleep disruption, and individual dietary factors are also reported by some patients, although these are not identical for everyone.
A symptom diary can help you look for repeated patterns without assuming that every flare has one simple cause. Never stop prescribed medication without speaking with the prescriber.
Stress was one of my clearest personal triggers. I write more about that relationship in Stress and Palmoplantar Pustulosis: How to Break the Flare-Stress Cycle.
09 Does diet affect palmoplantar pustulosis?
Research has not established one specific diet that treats PPP. However, some people, including me, notice personal food-related patterns and choose to explore them through a structured elimination and reintroduction process.
A balanced, nutrient-dense diet can support general health, but dietary changes should not replace appropriate medical care. Avoid long-term restriction without considering nutritional adequacy.
You can read more on the PPP diet page.
10 Who is most at risk of developing palmoplantar pustulosis?
PPP is most often diagnosed in adults and is reported more frequently in women. Smoking is one of the strongest known associations.
People can still develop PPP without smoking or fitting the typical profile, so risk factors should not be treated as a diagnosis.
11 How long do palmoplantar pustulosis flare-ups last?
The duration varies. Individual pustules may dry and change over days or weeks, while new crops can continue to appear. This can make one flare feel as though it lasts much longer.
Seek medical advice if the condition is rapidly worsening, extremely painful, showing signs of infection, or making it difficult to walk or use your hands.
For the practical measures that helped me cope during painful flares, see Palmoplantar Pustulosis Pain Relief: What Actually Works During a Flare.
12 Can palmoplantar pustulosis go into remission?
Yes. Some people experience extended periods with few or no symptoms, although the course of PPP varies and future flare-ups cannot be ruled out.
I have personally remained in remission for more than fifteen years. That is my experience, not a guarantee that the same approach will produce the same result for everyone.
You can read my full experience on the Palmoplantar Pustulosis Remission page.
Immune activity, supplements, SAPHO syndrome, and childhood PPP.
13 Is palmoplantar pustulosis an autoimmune disease?
PPP is an immune-mediated inflammatory disease. Its classification is complex: some sources describe it within the pustular psoriasis spectrum, while others treat it as a closely related but distinct condition.
What is clear is that abnormal inflammatory signalling in the skin plays an important role.
14 Does palmoplantar pustulosis spread to other areas of the body?
PPP itself is normally concentrated on the palms and soles. Some people also have plaque psoriasis or other skin changes elsewhere.
New pustules, widespread redness, fever, or rapidly changing skin should be assessed by a healthcare professional rather than assumed to be ordinary PPP.
15 What vitamins and supplements help with palmoplantar pustulosis?
No vitamin or supplement has been proven to cure PPP. Correcting an identified deficiency may support general health, but taking more than you need is not automatically beneficial.
Vitamin D, zinc, magnesium, and omega-3 supplements are commonly discussed by patients. The appropriate dose depends on diet, blood test results, medication, and individual health risks. Check with a qualified professional before starting supplements or combining them.
16 Is palmoplantar pustulosis related to SAPHO syndrome?
PPP is associated with SAPHO syndrome, a rare condition involving inflammatory bone, joint, and skin symptoms.
Tell your doctor if PPP occurs alongside persistent chest-wall pain, bone pain, joint swelling, or other unexplained musculoskeletal symptoms. These symptoms do not automatically mean that you have SAPHO, but they may justify further assessment.
For a separate discussion of PPP and inflammatory joint symptoms, see Palmoplantar Pustulosis and Psoriatic Arthritis.
17 Can children get palmoplantar pustulosis?
Yes, but PPP is uncommon in children. Recurrent pustules on a child's palms or soles can have several possible causes and should be assessed by a doctor, preferably a paediatric dermatologist when available.
Stress, gut health, and finding a doctor who understands PPP.
18 How does stress affect palmoplantar pustulosis?
Stress is frequently reported as a trigger or aggravating factor. I noticed a clear relationship between periods of high stress and my own symptoms.
Stress management cannot replace medical treatment, but improving sleep, pacing, recovery time, and access to psychological support may form a useful part of a wider management plan.
Read more about my personal experience in Stress and Palmoplantar Pustulosis: How to Break the Flare-Stress Cycle.
19 Is there a link between palmoplantar pustulosis and gut health?
Researchers are increasingly interested in connections between the gut microbiome, immune signalling, and inflammatory disease. However, there is not yet an established gut-healing protocol proven to treat PPP.
Supporting digestive and general health through a varied diet, adequate fibre where tolerated, regular meals, and appropriate medical assessment may still be worthwhile. Persistent digestive symptoms should be investigated rather than automatically attributed to “leaky gut.”
I explore this topic further in How the Modern Diet Damages Gut Health — and Why This Matters for Palmoplantar Pustulosis.
20 How do I find a doctor who understands palmoplantar pustulosis?
Ask your primary-care doctor for a referral to a dermatologist. When arranging the appointment, use the full term “palmoplantar pustulosis” rather than only saying “psoriasis.”
Bring photographs from different stages of a flare, a symptom timeline, a list of current and previous medicines, and notes about possible triggers. Ask what diagnoses have been considered, what tests may be useful, and how treatment will be monitored.
The Palmoplantar Pustulosis Global Support Group can also provide peer support and shared experiences, although personal recommendations do not replace professional medical assessment.
Go deeper into the questions people ask most often.
These articles expand on diagnosis, prevalence, painful flares, stress, gut health and inflammatory joint symptoms.
The complete PPP framework is explained in my book.
How to Treat Palmoplantar Pustulosis Naturally brings together my personal journey, possible triggers, symptom relief, diet, supplements, stress, gut health, and the practical framework that helped me reach remission.