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Verruca plantaris — Clinical Guidelines

Overview

Verruca plantaris, often associated with pustulosis palmaris et plantaris (PPP), is a chronic skin condition characterized by recurrent pustules and scaling on the palms and soles. It is frequently linked to focal tonsillar infections and may involve immune complex formation and aberrant T-cell responses 8 10.

Diagnosis

Clinical Presentation: Recurrent pustules and scaling on palms and soles.

Associated Factors: History of focal tonsillar infections, elevated antibody titers against streptococci 8.

Laboratory Tests: Detection of immune complexes via Clq-binding test in serum 10.

Imaging/Other Tests: Not typically required; tonsillar examination may be considered in suspected cases 6.

Management

First-Line Treatments:

- Tonsillectomy: Effective in 76% of cases, particularly when performed early post-onset and in patients with mild tonsillar hypertrophy 9.

Adjunctive Treatments:

- Anti-inflammatory Agents: Topical corticosteroids or systemic nonsteroidal anti-inflammatory drugs (NSAIDs) for symptom relief 10. - Immune Modulation: Management of underlying immune responses, though specific agents not detailed in abstracts.

Special Populations

Pediatrics: Not specifically addressed in abstracts.

Elderly: Not specifically addressed in abstracts.

Comorbidities: Smoking is associated with onset and exacerbation; humid seasons may influence incidence 4.

Pregnancy: Not discussed in provided abstracts.

Key Recommendations

Consider Tonsillectomy for Persistent Cases: Indicated for patients with suspected focal tonsillar infections and persistent PPP symptoms, showing significant improvement in 76% of cases 9 (Evidence: Moderate).

Evaluate for Immune Complexes: Screen patients for immune complexes via Clq-binding test, as a high level correlating with skin lesion improvement post-tonsillectomy 10 (Evidence: Moderate).

Address Smoking Habits: Screen and counsel patients on smoking cessation due to its association with PPP onset and severity 4 (Evidence: Moderate).

References

1 Sakiyama H, Kobayashi S, Dianzani U, Ogiuchi H, Kawashima M, Uchiyama T et al.. Possible involvement of T cell co-stimulation in pustulosis palmaris et plantaris via the induction of inducible co-stimulator in chronic focal infections. Journal of dermatological science 2008. link 2 Murakata H, Harabuchi Y, Kukuminato Y, Yokoyama Y, Kataura A. Cytokine production by tonsillar lymphocytes stimulated with alpha-streptococci in patients with pustulosis palmaris et plantaris. Acta oto-laryngologica. Supplementum 1996. link 3 Hayashi Y, Kunimoto M, Kuki K, Yamanaka N. Animal model of focal tonsillar infection: human tonsillar lymphocytes induce skin lesion in SCID mice. Acta oto-laryngologica. Supplementum 1996. link 4 Akiyama T, Seishima M, Watanabe H, Nakatani A, Mori S, Kitajima Y. The relationships of onset and exacerbation of pustulosis palmaris et plantaris to smoking and focal infections. The Journal of dermatology 1995. link 5 Nakamura T, Ono T, Aoki Y. Medullasin levels in neutrophils of patients with pustulosis palmaris et plantaris. The Journal of dermatology 1993. link 6 Noda Y. Pre-operative diagnosis for dermatoses due to tonsillar focal infections: recent views. Auris, nasus, larynx 1989. link80031-8) 7 Ikawa T, Maehara T, Eura M, Kitao Y, Ishikawa T. Autologous immune response of tonsillar lymphocytes. Acta oto-laryngologica. Supplementum 1988. link 8 Ito H, Suzuki Y. The tonsils and pustulosis palmaris et plantaris as viewed against the genetic background. Acta oto-laryngologica. Supplementum 1983. link 9 Noda Y, Ura M. Pustulosis palmaris et plantaris due to tonsillar focal infections. From the analysis of long-term observed cases. Acta oto-laryngologica. Supplementum 1983. link 10 Yamanaka N, Sambe S, Kataura A. Conceptual understanding of pustulosis palmaris et plantaris as an immune complex disease due to focal tonsillar infections. Acta oto-laryngologica. Supplementum 1983. link 11 Harper PS. Genetic heterogeneity in hyperkeratosis palmaris et plantaris. Birth defects original article series 1971. link

Verruca plantaris