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Women are more frequently affected than men, and smoking is a major trigger. Under biologic therapies, especially TNF antagonists, a paradoxical PPP may occur. PPP is associated with psoriasis vulgaris and may be accompanied by osteoarticular involvement. Pathogenetically, PPP likely begins around the acrosyringium, with the pustules consisting almost exclusively of infiltrating neutrophilic granulocytes attracted by chemotactic factors secreted by activated keratinocytes. Inflammation is sustained through a self\u2010amplifying cytokine network, including interleukin (IL)\u201017, IL\u201019, and related mediators.<\/jats:p>\n                  <jats:p>Treatment options for PPP include topical treatments, UV\u2010phototherapies \u2010 particularly topical PUVA (Psoralen plus UVA) therapy\u2010 and systemic therapies. Systemic agents comprise conventional treatments such as acitretin, methotrexate, fumaric acid esters, and ciclosporin, newer small molecules like apremilast and Janus kinase inhibitors, as well as biologics. Conventional systemic therapies are often not sufficiently effective in PPP and associated with side effects. Currently, among systemic therapies, only acitretin is approved for PPP. In recent years, placebo\u2010controlled studies have demonstrated a significant effect of apremilast, brodalumab, guselkumab and risankizumab on PPP, and further studies with topical and systemic Janus kinase inhibitors as well as IL\u201017A\/F inhibitors are underway.<\/jats:p>","DOI":"10.1111\/ddg.70238x","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:30:48Z","timestamp":1775644248000},"page":"516-535","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Palmoplantar pustulosis: pathogenesis, differential diagnosis, and treatment"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2476-7647","authenticated-orcid":false,"given":"Rotraut","family":"M\u00f6ssner","sequence":"first","affiliation":[{"name":"Department of Dermatology Venereology and Allergology University Medical Center G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanja","family":"Fetter","sequence":"additional","affiliation":[{"name":"Center for Skin Diseases Department of Dermatology and Allergology University Hospital Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Sabat","sequence":"additional","affiliation":[{"name":"Translational Skin Inflammation Research Department of Dermatology Venereology and Allergology Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin corporate member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9539-0712","authenticated-orcid":false,"given":"Ulrich","family":"Mrowietz","sequence":"additional","affiliation":[{"name":"Center for Inflammatory Skin Diseases Department of Dermatology Venereology and Allergology University Medical Center Schleswig\u2010Holstein Campus Kiel  Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neda","family":"Cramer","sequence":"additional","affiliation":[{"name":"Department of Dermatology Venereology and Allergology University Medical Center G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5594-7192","authenticated-orcid":false,"given":"Dagmar","family":"Wilsmann\u2010Theis","sequence":"additional","affiliation":[{"name":"Center for Skin Diseases Department of Dermatology and Allergology University Hospital Bonn  Bonn 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