title: Exacerbation of pustulosis palmaris et plantaris after topical application of metals accompanied by elevated levels of leukotriene B4 in pustules.
abstract: BACKGROUND
  Pustulosis palmaris et plantaris (PPP) is a chronic inflammatory disease consisting of polymorphonuclear leukocyte infiltration, and is often exacerbated by focal infections such as tonsillitis. In some cases, metal allergy has been reported.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate (1) the significance of metal allergy in the formation of pustules, and (2) the participation of leukotriene (LT) B(4) in the formation of pustules of PPP.
  
  
  METHODS
  Patch tests with metals were performed on 7 patients with PPP, and both pustular and plasma levels of LTB(4) were measured in these 7 patients before and 48 hours after metal patch tests.
  
  
  RESULTS
  Palmoplantar pustules were exacerbated after the metal patch tests in all 7 patients. The mean levels of LTB(4) in plasma and pustules of the volar surface at 48 hours after the metal patch tests were significantly higher than those before the metal patch tests.
  
  
  CONCLUSIONS
  Metals can be important in the pathogenesis of PPP by contributing to the induction of high LTB(4) concentration in the pustules.
authors.affiliation: Department of Dermatology, University of Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Nakamura
authors.forename: S
authors.initials: S
authors.lastname: Imakado
authors.forename: M
authors.initials: M
authors.lastname: Takizawa
authors.forename: M
authors.initials: M
authors.lastname: Adachi
authors.forename: M
authors.initials: M
authors.lastname: Sugaya
authors.forename: M
authors.initials: M
authors.lastname: Wakugawa
authors.forename: A
authors.initials: A
authors.lastname: Asahina
authors.forename: K
authors.initials: K
authors.lastname: Tamaki
mesh_terms: D000287:Administration, Topical; D005260:Female; D006801:Humans; D006967:Hypersensitivity; D007975:Leukotriene B4 / Q000097:blood*; D008297:Male; D008670:Metals / Q000009:adverse effects* / Q000276:immunology; D008875:Middle Aged; D010328:Patch Tests; D011565:Psoriasis / Q000139:chemically induced* / Q000276:immunology
chemical_list: D008670:Metals; D007975:Leukotriene B4