PALMOPLANTAR PUSTULOSIS - A CLINICAL AND IMMUNOHISTOLOGICAL STUDY

Pustulosis palmoplantaris (PPP) is a common chronic skin disease, whic h is very resistant to treatment. It is not known why the lesions are located in the palms and soles. There are few studies of the disease a nd in particular studies of the histology. Fifty-nine patients with PP P answered a questionnaire concerning their medical history and 39 of them were clinically examined. Biopsy specimens were taken from involv ed skin in 22 of the 39 patients and studied immunohistologically for tryptase+ mast cells, EG2+ eosinophils, lipocalin+ neutrophils and CD3 + T lymphocytes. The sweat gland and sweat duct were visualized with A E1/AE3 antibody (cytokeratins 1-8, 10, 14/15, 16, 19). In addition to neutrophils in the pustule and lymphocytes in the upper dermis, there were also large numbers of mast cells and eosinophils in the subpustul ar area. Numerous eosinophils were present in the pustule. The epiderm al part of the eccrine duct was not detectable in any of the specimens from patients with PPP but was present in all of the nine control per sons (including two smokers). The results indicate that the acrosyring ium is involved in the inflammation and also that mast cells and eosin ophils participate in a hitherto unknown wan. Of the 39 patients clini cally examined, two had previously diagnosed thyroid disease and two h ad gluten hypersensitivity. Seventeen had one or several abnormal seru m concentrations of thyroid-stimulating hormone, thyroxin, antibodies against thyroglobulin or thyroperoxidase and 10 had immunoglobulin (Ig ) A antibodies to gliadin. The mean +/-SD for serum IgA and for eosino phil cationic protein was increased. From the questionnaire the most n otable finding was that 56 of the 59 patients had been or still were s mokers, all of whom had started smoking before the first. signs of PPP . We hypothesize that the acrosyringium might be the target for the in flammation and that PPP is linked to autoimmune thyroid disease and sm oking.