Author: Dr Karen Koch, Dermatologist, Wits University Donald Gordon Medical Centre, Johannesburg, South Africa. DermNet Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell/Maria McGivern. July 2018.
Porokeratosis plantaris, palmaris et disseminata (PPPD) is an extremely rare form of porokeratosis in which scaly red-brown annular patches arise on the patient's palms and soles and spread to the extremities and trunk [2].
Who gets porokeratosis plantaris, palmaris et disseminata?
The onset of PPPD is usually during the teenage years, although there are rare reports of the onset of PPPD later in life [3]. PPPD was originally reported to be twice as common in men than women [2].
PPPD generally worsens during summer [2].
What causes porokeratosis plantaris, palmaris et disseminata?
Most often, PPPD occurs as a geneticautosomal dominant condition that runs in families [4]. However, sporadic cases may arise [5].
What are the clinical features of porokeratosis plantaris, palmaris et disseminata?
PPPD usually presents initially as red-brown annular patches on the patient's palms of the hands and soles of the feet. These lesions spread to the extremities and trunk forming reddish and slightly thinned small patches with defined borders [1,2].
Skin lesions on the palms and soles can be painful in about 25% of cases [2].
In some cases of PPPD, the skin lesions on the palms and soles are pinpoint scalypapules called punctate porokeratosis — it unclear whether this is a variant of PPPD [6].
What are the complications of porokeratosis plantaris, palmaris et disseminata?
PPPD is chronic and progressive and can affect the quality of life. There is a small risk of progression to cutaneous squamous cell carcinoma in long-standing cases [7].
How is porokeratosis plantaris, palmaris et disseminata diagnosed?
What is the differential diagnosis of porokeratosis plantaris, palmaris et disseminata?
The differential diagnosis for PPPD is mainly other forms of porokeratosis, especially DSAP. DSAP has similar skin lesions to PPPD on the patient's limbs, but its lesions are uncommon on the trunk and, usually, the hands and feet are spared. DSAP tends to affect sun-exposed areas whereas PPPD can affect any part of the body.
What is the treatment for porokeratosis plantaris, palmaris et disseminata?
There is no known cure for PPPD and treatment is generally disappointing. Some patients respond well to the oral retinoids, acitretin or isotretinoin.
What is the outcome for porokeratosis plantaris, palmaris et disseminata?
PPPD is chronic and progressive. It tends to fluctuate in severity, often worsening in summer. Some people respond well to oral isotretinoin or acitretin, but most often the condition relapses when the medication is stopped.
Gutierrez EL, Galarza C, Ramos W, et al. Facial porokeratosis: a series of six patients. Australas J Dermatol 2010; 51: 191–4. doi: 10.1111/j.1440-0960.2009.00616.x. PubMed
Guss SB, Osbourn RA, Lutzner MA. Porokeratosis plantaris, palmaris, et disseminata. A third type of porokeratosis. Arch Dermatol 1971; 104: 366–73. PubMed
Hartman R, Mandal R, Sanchez M, Stein JA. Porokeratosis plantaris, palmaris, et disseminata. Dermatol Online J 2010; 16: 22. PubMed
Wei SC, Yang S, Li M, et al. Identification of a locus for porokeratosis palmaris et plantaris disseminata to a 6.9-cM region at chromosome 12q24.1-24.2. Br J Dermatol 2003; 149: 261–7. PubMed
Shaw JC, White CR Jr. Porokeratosis plantaris palmaris et disseminata. J Am Acad Dermatol 1984; 11: 454–60. PubMed
Sasson M, Krain AD. Porokeratosis and cutaneous malignancy. A review. Dermatol Surg 1996; 22: 339–42. PubMed
Marschalkó M, Somlai B. Porokeratosis plantaris, palmaris, et disseminata. Arch Dermatol 1986; 122: 890–1. PubMed