2019 Volume 65 Issue 7 Pages 447-454
Palmoplantar pustulosis (PPP) is a refractory skin disorder exhibiting numerous sterile pustules on the palms and soles of the patients. PPP is related to dental focal infection and metal allergy, and the experts in dermatology and dentistry have worked together to arrive at a consensus regarding the diagnosis and treatment of PPP. However, the obvious cause of PPP remains unknown, and a standard treatment has yet to be established. In this study, we aimed to clarify the relation of PPP to dental focal infection and dental metal allergy. We evaluated 29 patients with PPP who underwent oral examination and patch testing in the Department of Oral Medicine at Hokkaido University Hospital from July 2010 through May 2014. In total, 22 of the 29 patients had positive patch test results, and flare-up was observed in one patient. Metallic component analysis revealed that the oral cavity was metal-positive in 14 of 22 patch test-positive patients. In contrast, odontogenic foci were found in 25 of 29 patients.
Among 14 patients who had positive patch-test results for metal in the oral cavity, the course after metal removal could be confirmed in nine patients, and skin symptoms improved in all patients. Among 15 patients who did not have patch-test results for metal in the oral cavity, the course after treatment of odontogenic foci could be confirmed in eight patients, and symptoms improved in only one patient.
This study resulted in a higher rate of improvement after removal of dental metals versus treatment of odontogenic foci, suggesting that PPP strongly correlates with dental metal allergy. However, because odontogenic foci may be treated concurrently with metal removal, an association between PPP and dental focal infection cannot be denied. In addition to the time and cost burden of metal removal, symptoms may improve naturally in some cases. Therefore, we suggest that it is necessary to consider the suitability of metal removal on a case-by-case basis.
