The role of palatine tonsil in the pathogenesis of pustulosis palmaris et plantaris

Abstract

Pustulosis palmaris et plantaris (PPP) is a skin disease considered to be caused by a focal infection of the palatine tonsils. We studied patients with PPP, recurrent tonsillitis and tonsillar hypertrophy, from whom tonsillar mononuclear cells (TNMC) and peripheral blood mononuclear cells (PBMC) were isolated; PBMC were collected again 6 months after surgery. The number of keratin-specific antibody-forming cells (AFC) in TNMC was found to be greater than those in PBMC as determined by ELISPOT assays, and were increased in patients with PPP when compared with patients with recurrent tonsillitis or tonsillar hypertrophy. In patients showing a remarkable improvement of PPP, the number of keratin-specific IgA AFC in TNMC was higher than in those who showed no improvement in their skin lesions. Further, the numbers of keratin-specific IgG AFC in PBMC were significantly decreased after surgery in patients with a good prognosis. The present results demonstrated the presence of keratin-specific immune responses in palatine tonsils. Further, keratin-specific IgA and IgG immune response in tonsils and peripheral blood were significantly correlated with the prognosis of PPP. Together, these findings suggest that keratin-specific immune responses in palatine tonsils might be associated with the pathogenesis of PPP.