Conceptual understanding of pustulosis palmaris et plantaris as an immune complex disease due to focal tonsillar infections.

The relationship between pustulosis palmaris et plantaris (PPP) and immune complexes was studied in 17 patients who underwent tonsillectomy. By means of the Clq-binding test, immune complexes were detected in a considerable number of sera from these patients. Patients with a high serum level of immune complexes which decreased following tonsillectomy were found to benefit by a remarkable improvement in their skin lesions. There was a close association between the degree of improvement in skin lesions following tonsillectomy, and the changes in circulating immune complex levels after tonsillectomy. Immunofluorescence showed that all 6 patients with PPP tested had deposits of IgG, IgM, IgA or C3 in their skin lesions. These results suggest that PPP may be an immune complex disease, and that it may be closely associated with the tonsil as a focus for the release of antigens or immune complexes.