Palmoplantar pustulosis (PPP) is a relapsing vesiculopustular eruption of the palms and soles, with onset usually occurring in middle aged adults. To clarify the long term prognosis of PPP after tonsillectomy, multi-choice questionnaires were mailed to 331 patients, i.e. 61 with tonsillectomy (tonsillectomy group) and 270 without tonsillectomy (non-tonsillectomy group). These patients were diagnosed as having PPP between 1988 and 2008 by dermatologists at the Ryukyu University Hospital and followed up by them at least for one year. Patients had tonsillectomies for intractable PPP compared with the usual dermatologic treatments.
The response rate to the written questionnaire was 36.8% (122/331), comprising 30 in the tonsillectomy group and 92 in the group without tonsillectomy. The improvement rates of pustules with skin redness and pruritis-associated pain were 83.3% and 76.7% in the tonsillectomy group, and 84.7% and 73.9% the non-tonsillectomy group, respectively. The relapse rate of skin eruptions after tonsillectomy was 23.3% with an improvement of skin eruptions after relapse of 71.4%. The complete disappearance rate of skin symptoms in the tonsillectomy group was 63.3%, which was significantly higher than that (26.1%) in the non-tonsillectomy group. As the most effective treatment against PPP, 66.7% of patients selected tonsillectomy in the tonsillectomy group. Satisfaction rates for treatment were 70.0% in the tonsillectomy group and 33.7% in the non-tonsillectomy group, respectively. The satisfaction rate in the tonsillectomy group was significantly higher than that in the non-tonsillectomy group.
The present study clearly indicated that a favorable treatment outcome for PPP was obtained by tonsillectomy even in intractable cases and lasted considerably longer. As the satisfaction rate for tonsillectomy was also high in the tonsillectomy group, otolaryngologists should be involved in PPP treatment in cooperation with dermatologists.