What is Palmoplantar Pustulosis?
Palmoplantar Pustular Psoriasis (PPP) goes under a few different names such as Palmoplantar Pustulosis, and Pustulosis Palmoplantaris, they are all the same thing and I'm using the short version of the name which is PPP.
PPP is localised and appears on the palms of your hands and soles of your feet and is a difficult to treat skin condition. It occurs almost mostly in smokers (current or past), and it does not necessarily go away when the patient quits smoking. Basically It’s a chronic inflammatory illness characterized by accumulation of sterile pustules on the palms and soles that erupt repeatedly over time. there is an association with other autoimmune diseases particularly gluten sensitivity and celiac disease, thyroid disease and type 2 diabetes. As the little blisters or pustules are sterile they are not contagious but can seem so to somebody who doesn't know what it is, and esthetically it’s not a pretty site. The condition varies in severity and may persist for many years. It is not known what triggers flare-ups as there are not that many studies on the subject, but the onset of Palmoplantar Pustulosis has been closely linked with cigarette smoking in a number of studies from different parts of the world as well as recurrent strep throat infections. The general understanding is that PPP has little effect on the health in general, but can be very uncomfortable. Usually, pressure, rubbing and friction will worsen Palmoplantar Pustulosis . I don’t agree with the idea that Palmoplantar Pustulosis doesn't effect the general health, any autoimmune disease signals there are something very wrong and should be dealt with to avoid any other serious future health issues.
PPP is according to some researchers and findings part of the psoriasis family and to some not, the views differ here a bit as the genetic setup are not the same for the two . The crops of pustulosis may occur with psoriasis or like in my case without any other skin disease (apart from the Rosacea in my face) . The disease is very uncommon and there are no available data of how many percent of the general population is affected. The Swedish dermatology department have a outpatient data register which found an incidence of PPP in relation to other skin diseases of 0.37 percent of patients. Patients with signs of psoriasis elsewhere on the body were excluded in this study. The study dates back to 1971 and this percentage is more likely much higher now. Generally there are not a lot of statistics and information out there. Palmoplantar Pustulosis usually develops in middle-aged adults and seem to be more frequent in women than men.
Palmoplantar Pustulosis Case Study
There's a Swedish case study from 2005, which included 60 women with PPP where 95% of them were smoking or had been smokers in the past. Four of the patients (smokers) had no lesions at the time of blood sampling, but had shown typical mild to moderate Palmoplantar Pustulosis at earlier examination. Eight of these patients had psoriasis as well, which was usually mild and localized to the extremities.
The results of a of the study indicate that Palmoplantar Pustulosisis associated with a modest but highly significant increase of calcium in the body and a significant decrease in the PTH levels compared with healthy people who do not suffer from Palmoplantar Pustulosis. The PTH (Parathyroid hormone) is secreted by the parathyroid glands and is the most important regulator of calcium levels in the blood and within the bones, The parathyroid glands are small endocrine glands in the neck of humans and other tetrapods that produce parathyroid hormone. Parathyroid hormone (PTH) allows your body to pull calcium from your bones and tells your body to start making more activated vitamin D to absorb more calcium in the gut. This helps your body keep a narrow and healthy range of calcium in the blood. When calcium is just right in your blood, your PTH will lower and stop pulling calcium from your bones. None of the patients from the Swedish study used calcium and/or vitamin D supplements.
11 (18%) of these patience from the study also had celiac disease (gluten intolerance). The patients with Palmoplantar Pustulosis and with gluten intolerance had significantly lower unmodified and modified calcium than the patients with Palmoplantar Pustulosis with no evidence of gluten intolerance . Only one of the 11 patients with gluten intolerance had a previously known celiac disease, the other 10 were identified after screening for antibodies against gluten, which was performed in all patients with Palmoplantar Pustulosis. Those who were found to have antibodies were further examined with gastroscopy with duodenal biopsies (unpublished data). Two patients had had diabetes type 1 since adolescence, one of them also had a previously diagnosed celiac disease and the other had schizophrenia in addition to severe PPP. Fifteen patients had diabetes type 2 which they had received after their first outbreak of Palmoplantar Pustulosis. In seven, a dietary regimen was considered sufficient, eight received oral antidiabetics. Two patients had manic depressive disease. Nine other patients had long-term depressive symptoms including depression, anxiety or insomnia, and one had schizophrenia. They could not conclude if the link between depression and Palmoplantar Pustulosis were due to the general discomfort and the decrease of the quality of life caused by PPP, or if there was another factor.
To summarize the Swedish study, smoking plays a major part in the onset of Palmoplantar Pustulosis, even though no one is 100% sure why. There’s a Japanese study from 2002 performed on golden hamsters to see the effects smoking had on the parathyroid gland. The conclusion of the study is that smoking exposure increases the cellular activity of the parathyroid gland, and stimulates the cell cycle and release of PTH, as well as smoking exposure promotes bone resorption. Bone resorption is the process by which osteoclasts (a type of bone cell) break down bone and release the minerals, resulting in a transfer of calcium from bone fluid to the blood.
When there are high levels of calcium in the blood as seen in Palmoplantar Pustulosis patience, there's a decreased PTH release from the parathyroid gland which decreasing the number and activity of osteoclasts (bone cells), resulting in less bone resorption. Bone resorption is highly stimulated or inhibited by signals from other parts of the body, depending on the demand for calcium. There are no research or studies why this is connected to Palmoplantar Pustulosis outbreaks but a small Danish study revealed a significant decrease in bone mineral density in patients with Palmoplantar Pustulosis. The study suggests that PPP patients have a decreased bone mineral density due to primary pathogenic events (pathogenic = infectious agent such as bacteria, fungus parasite which causes disease in the host), and that osteoporosis may be an additional problem for patients with Palmoplantar Pustulosis.
In the Swedish study they would not rule out the possibility that there might be a disturbance in the function or production of vitamin D in PPP but there is no mention of vitamin K2 in that study (not to be mixed up with vitamin K1). Vitamin D3 increases absorption of calcium and phosphate in the intestinal tract but can't do this alone without help of vitamin K2. Vitamin K2 is necessary to convert a critical bone-building protein called osteocalcin. Osteocalcin is a necessary protein that helps maintain calcium homeostasis in bone tissue. It works with osteoblast cells to build healthy bone tissue. Inadequate K2 inhibits osteocalcin production and reduces calcium flow into bone tissue. This leads to reduced bone mass and a weakened bone matrix. Vitamin D3 and K2 play an essential role in calcium uptake into skeletal bone tissue. Several studies have shown a synergistic effect of vitamin K2 and D3. These studies show that this combination enhanced osteocalcin accumulation in bone cells. This increased osteocalcin formation significantly improved bone mineral density. Increased intakes of vitamin K2 may reduce the risk of developing type-2 diabetes, shows a new study with almost 40,000 Dutch men and women.
K2 Vitamin is produced by the good bacteria in the intestines and is a major source of vitamin K2. Long-term use of antibiotics can cause a vitamin K2 deficiency by killing these crucial bacteria in the gut who manufacture the vitamin K2. Other sources of the K2 vitamin from food are Natto, Hard cheese, Soft cheese, Egg yolk, Real organic Butter, Chicken liver, Salami, Chicken breast, Ground beef.
Based on research Palmoplantar Pustulosis seem to be trigged and caused by a combination of factors such as the abnormal cell activity in the parathyroid gland from smoking and the unbalance of the gut flora caused by antibiotics which causes the disturbance of D3 uptake as well as the lack of the vitamin K2 which inhibits the bodies natural process of calcium distribution. It is also confirmed that 18% of the Palmoplantar Pustulosis patience in the Swedish study suffer from gluten intolerance which I have written more about in my book How To Treat PPP Naturally,