A Journey to Healing: Overcoming Palmoplantar Pustular Psoriasis (PPP) 掌跖脓疱病

Case Reports

A 35-year-old woman who was otherwise healthy embarked on a challenging journey, grappling with worsening pain and blistering rashes that had plagued her palms for three years. Despite previous attempts with corticosteroid cream, relief remained elusive, prompting her to seek alternative non-immunosuppressive treatment in our clinic.

On examination, her once-smooth nails showed signs of discoloration, ridges, and thickening, indicating the severity of the condition. Additionally, her palms exhibited severe inflammation, with the affected areas emitting warmth and causing discomfort even with the slightest touch. To add to her distress, small fluid-filled bumps adorned her inflamed fingers.

With a nod to her previous diagnosis of Palmoplantar Pustular Psoriasis (PPP) by her dermatologist, we embarked on a comprehensive treatment approach. A tailored regimen of TCM herbal oral medicines, including Tangs Derma and Tangs Psoria, accompanied by our herbal Lite Balm and Yufu cream, was prescribed. Simultaneously, the use of steroids was discontinued, paving the way for a new chapter in her healing journey.

Initially, the transition away from steroids precipitated a tumultuous reaction in her skin. The steroid withdrawal triggered a surge in her symptoms, with the number and size of reddish lesions multiplying, accompanied by relentless itchiness. However, amidst the storm, a glimmer of hope emerged. By the eighth month, the tide began to turn. Her symptoms gradually receded, and the once-prominent lesions began to flatten, hinting at the promise of relief on the horizon. Though cycles of regression and reactivation echoed her previous encounters with steroids, each flare grew milder with the passage of time.

After thirty months of unwavering dedication to the TCM treatment plan, a remarkable transformation unfolded before her eyes. Her deformed fingernails returned to their former glory, and her palms regained their natural skin tone, serving as a testament to the power of perseverance and the healing potential of holistic herbal medicine.

PustularPsoriasis2A

For a comprehensive overview of the treatment progress and monthly follow-up photographs, please refer to the YouTube video linked here: https://youtu.be/GUMZVXp_GwM

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Discussion

Palmoplantar pustular psoriasis (PPP) aka pustulosis palmoplantaris, and pustulosis palmaris et plantaris. PPP is a type of psoriasis, a chronic autoimmune skin condition that affects the palms and soles specifically, causing discomfort, pain, and sometimes deformities in severe cases. It is characterized by the development of small, fluid-filled blisters (pustules) on the skin, along with redness, scaling, and inflammation. In some cases, palmoplantar pustular psoriasis can also lead to nail deformities, such as pitting, ridges, discoloration, and thickening of the nails. These nail changes can cause cosmetic concerns and may also result in pain and discomfort. 

When the nails are affected in PPP, it can manifest in various ways, including:

  1. Pitting: Small pits or punctate depressions may develop on the surface of the nails. These pits are often shallow but can sometimes be deeper.
  2. Discoloration: The nails may become discolored, appearing yellowish, brownish, or even red due to inflammation and the presence of pustules underneath the nail plate.
  3. Thickening: The nails may thicken and become rough or irregular in texture. This can make them more prone to breakage or separation from the nail bed.
  4. Onycholysis: Onycholysis refers to the separation of the nail plate from the nail bed. In PPP, this separation can occur due to inflammation and the buildup of pus beneath the nail plate.
  5. Subungual hyperkeratosis: There may be an accumulation of keratin debris underneath the nail plate, leading to thickening and yellowish discoloration of the nails.
  6. Nail bed pustules: Pustules may form along the edges of the nail bed or underneath the nail plate, causing pain, tenderness, and discomfort.

Privacy

In situations where the disease information had already been made publicly available (as evidenced by prior articles), genuine names of individuals have been utilized. Conversely, in instances where there was no pre-existing public disclosure or at the explicit request of patients for privacy, pseudonyms have been employed. Furthermore, identities have been deliberately obscured, and certain contextual details and diagnoses have been modified to hinder any attempts at identification. It is essential to emphasize that the patients and encounters described in this work are authentic, and their consent for publication was duly obtained. As responsible authors, we earnestly implore all our readers to honor the privacy and confidentiality of these individuals. Additionally, certain scenarios, assessments, and clinical interventions have been altered to safeguard the anonymity of both patients and healthcare providers.