**4.2 Pustulosis palmaris et plantaris, and dyshidrotic eczema**

In these patients, erythema, blisters with pustules, scale and crust typically appear on the palm and plantar (Fig. 3). In addition, sterile pustules are sometimes accompanied by itch, heat and painful sensations, and on occasion, osteoarthritis may also be found. Osteoarthritis symptoms involve the trunk, peripheral nerves, and the extra-articular region, and frequently there is local swelling, tenderness, heat sensation, and flare noted in these patients. During the early stages, histological findings show there is lymphocyte infiltration into the epidermis along with spongy degeneration. After formation of blisters and at the point where the blister reaches the horny cell layer, neutrophils appear and pustule development begins. At the present time, detailed pathoetiology of these symptoms has yet to be reported. Focal infection of the chronic inflammation from the palatine tonsil, marginal and periapical periodontitis, and metal allergy are all suspected as being predisposing factors.

(a) Pustulosis Palmaris (b) Pustulosis Palmaris

(c) Pustulosis Palmaris (crooked nails) (d) Pustulosis Plantaris

Fig. 3. Pustulosis palmaris et plantaris and dyshidrotic eczema.
