{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:31:05Z","timestamp":1787841065719,"version":"build-2784847793"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Patients with palmoplantar pustulosis (PPP) rarely develop scaly erythematous and\/or pustular lesions on sites other than the palms and soles, such as the dorsa of the feet, lower legs, knees, elbows, buttocks and trunk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>This study aims to evaluate the characteristics of extra-palmoplantar lesions of Japanese patients with PPP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>Twenty-three patients (seven males and 16 females) with PPP and extra-palmoplantar lesions were examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The extra-palmoplantar lesions were classified into scaly, erythematous lesions (chronic type) (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 15) and pustular lesions surrounded by erythema (acute type) (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 8). In cases of acute exacerbation, multiple solitary pustules with or without scaly erythema developed following infection such as upper respiratory tract infection, tonsilitis, sinusitis and appendicitis. The frequency of joint manifestations was significantly higher in patients with acute type, as compared with chronic type (75.0%\n                      <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                      13.3%). The histopathological features of scaly erythemas were focal parakeratosis, mild irregular acanthosis of the epidermis and mild mononuclear cell infiltration in the upper dermis, whereas Munro\u2019s microabscess was not observed in any cases. In contrast, a histopathological feature of the pustular lesion was consistent with that of pustular psoriasis. Expression of S100 family alarmin, CCL20 and CCR6 interaction and IL-36 was upregulated in the extra-palmoplantar lesional skin of PPP.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      Alarmins triggered by mechanical stimuli induced extra-palmoplantar lesions of PPP,\n                      <jats:italic toggle=\"yes\">via<\/jats:italic>\n                      CCL20\/CCR6 interaction and IL-36. Extra-palmoplantar lesions can occur on pre-existing scars, in which tissue-resident memory T cells may be activated by mechanical stimuli and induce inflammatory cytokines.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijd.ijd_648_24","type":"journal-article","created":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T08:00:18Z","timestamp":1757750418000},"page":"336-341","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Extra-Palmoplantar Lesions of Palmoplantar Pustulosis: Underrecognized but Important Manifestation"],"prefix":"10.4103","volume":"70","author":[{"given":"Toshiyuki","family":"Yamamoto","sequence":"first","affiliation":[{"name":"From the Department of Dermatology, Fukushima Medical University, Fukushima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"R1-20251031","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1111\/j.1468-3083.2009.03296.x","article-title":"Extra-palmoplantar lesions associated with palmoplantar pustulosis","volume":"23","author":"Yamamoto","year":"2009","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"R2-20251031","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s40261-018-00745-6","article-title":"Clinical characteristics of Japanese patients with palmoplantar pustulosis","volume":"39","author":"Yamamoto","year":"2019","journal-title":"Clin Drug Investig"},{"key":"R3-20251031","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/ijd.14788","article-title":"Characteristics of Japanese patients with pustulotic arthro-osteitis associated with palmoplantar pustulosis: A multicenter study","volume":"59","author":"Yamamoto","year":"2020","journal-title":"Int J Dermatol"},{"key":"R4-20251031","doi-asserted-by":"crossref","first-page":"e210","DOI":"10.1111\/1346-8138.15291","article-title":"Tissue resident memory T cells in the lesional and unlesional psoriatic skin on the scar","volume":"47","author":"Yamamoto","year":"2020","journal-title":"J Dermatol"},{"key":"R5-20251031","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1111\/1346-8138.15100","article-title":"Pathogenic role of palatine tonsils in palmoplantar pustulosis: A review","volume":"46","author":"Harabuchi","year":"2019","journal-title":"J Dermatol"},{"key":"R6-20251031","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1111\/j.1468-3083.2006.02065.x","article-title":"Koebner's phenomenon associated with palmoplantar pustulosis","volume":"21","author":"Yamamoto","year":"2007","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"R7-20251031","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1038\/s41423-019-0291-4","article-title":"Tissue-resident memory T cells and their biological characteristics in the recurrence of inflammatory skin disorders","volume":"17","author":"Chen","year":"2020","journal-title":"Cell Mol Immunol"},{"key":"R8-20251031","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1111\/j.1600-0625.2012.01571.x","article-title":"Novel insights into the role of S100A8\/A9 in skin biology","volume":"21","author":"Kerkhoff","year":"2012","journal-title":"Exp Dermatol"},{"key":"R9-20251031","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.3389\/fimmu.2018.01298","article-title":"S100A8\/A9 in inflammation","volume":"9","author":"Wang","year":"2018","journal-title":"Front Immunol"},{"key":"R10-20251031","doi-asserted-by":"crossref","first-page":"6621","DOI":"10.4049\/jimmunol.164.12.6621","article-title":"Up-regulation of macrophage inflammatory protein-3 alpha\/CCL20 and CC chemokine receptor 6 in psoriasis","volume":"164","author":"Homey","year":"2000","journal-title":"J Immunol"},{"key":"R11-20251031","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1034\/j.1600-0625.2002.110205.x","article-title":"Expression of the C-C chemokine MIP-3 alpha\/CCL20 in human epidermis with impaired permeability barrier function","volume":"11","author":"Schmuth","year":"2002","journal-title":"Exp Dermatol"},{"key":"R12-20251031","doi-asserted-by":"crossref","first-page":"2175","DOI":"10.1038\/jid.2009.65","article-title":"Th17 cytokines stimulate CCL20 expression in keratinocytes in vitro and in vivo: Implications for psoriasis pathogenesis","volume":"129","author":"Harper","year":"2009","journal-title":"J Invest Dermatol"},{"key":"R13-20251031","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1038\/jid.2010.340","article-title":"Integrative responses to IL-17 and TNF-? 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