Palmoplantar Pustulosis Remission: Is It Possible?
When I was at my worst with palmoplantar pustulosis, unable to walk without pain, unable to hold a pen or cup without cringing, my doctor told me there was no cure. No lasting relief. Just management.
I refused to accept that as the whole story.
Today, more than 15 years after my last significant flare-up, I live fully symptom-free. I walk, run, exercise, cook, and live my life without fear of PPP returning. That is what remission looks like, and it is real.
I refused to accept that as the whole story.
Today, more than 15 years after my last significant flare-up, I live fully symptom-free. I walk, run, exercise, cook, and live my life without fear of PPP returning. That is what remission looks like, and it is real.
What Does Remission Mean for PPP?
In the context of palmoplantar pustulosis, remission means a sustained period, months or years, without active pustules, significant inflammation, or the painful skin breakdown that characterises flare-ups.
It is important to be honest: remission in PPP does not always mean the condition is permanently gone. For some people, remission lasts months. For others, like me, it lasts years or even becomes permanent. The distinction lies largely in whether the underlying triggers have been genuinely addressed or merely suppressed.
It is important to be honest: remission in PPP does not always mean the condition is permanently gone. For some people, remission lasts months. For others, like me, it lasts years or even becomes permanent. The distinction lies largely in whether the underlying triggers have been genuinely addressed or merely suppressed.
What the Research Says
Studies on PPP remission rates vary, partly because PPP is rare and research has historically been limited. What the literature consistently shows is:
- Spontaneous remission can occur
- Long-term remission is more achievable when multiple triggers are addressed simultaneously
- Diet, stress, and gut health interventions have shown promise in patient-reported outcomes
- Biologics and systemic medications can induce remission, but relapse is common when treatment stops
The Factors That Took Me Into Remission
My path to remission was not a single breakthrough. It was a series of consistent changes over about 3 months, each one reducing the inflammatory load on my body until flare-ups stopped occurring.
Removing dietary triggers
Gluten and sugar were my biggest dietary triggers. Removing them, and switching to an anti-inflammatory, whole-food diet, dramatically reduced my baseline inflammation. My skin had a chance to heal between cycles rather than perpetually chasing its tail.
Supporting gut health
I came to believe that my gut health was at the centre of my immune dysregulation. Focusing on gut repair through probiotics, fermented foods, and an elimination of processed foods was a slow but transformative process.
Optimising key nutrients
Vitamin D deficiency is documented in many autoimmune conditions including PPP. Getting my vitamin D levels into an optimal range, not just the bare minimum, was part of my recovery. Zinc and magnesium also played supporting roles.
Reducing chronic stress
Stress was the trigger I underestimated the longest. Even when my diet was perfect, sustained stress would bring on a flare. Learning to genuinely rest, not just relax on the surface, but actually restore my nervous system, was the final piece of my remission puzzle.
What Remission Actually Feels Like
I want to paint a picture of what life in PPP remission looks like, because when you are in the depths of a flare, it can be impossible to imagine.
- Waking up without dreading putting your feet on the floor
- Walking barefoot on grass, on a beach, in your own home
- Shaking hands with someone without self-consciousness
- Going through a whole week, and then a whole month, without thinking about your skin
- Planning a holiday and not worrying about whether your feet will hold up
Can Remission Be Permanent?
In my case, yes, so far. Over 15 years without a significant flare-up. But I stay mindful of my triggers. I maintain my diet, manage my stress, and pay attention to what my body tells me.
I think of it this way: I have not been cured in the sense that the underlying predisposition is gone. I have created conditions in which my body no longer expresses the disease. Maintain those conditions, and the remission holds.
I think of it this way: I have not been cured in the sense that the underlying predisposition is gone. I have created conditions in which my body no longer expresses the disease. Maintain those conditions, and the remission holds.
What About Others Who Have Reached Remission?
In the PPP support community I founded on Facebook, with thousands of members worldwide, I have heard from many people who have reached remission. Their paths are not all identical, some used biologics, some used dietary changes, some combined both. But the common thread among those who achieved lasting remission was this: they addressed root causes, not just symptoms.
Remission from palmoplantar pustulosis is possible.
It is not guaranteed, and it is not always easy.
But it is real, and thousands of patients have experienced it.
You deserve to know that.
