Palmoplantar pustulosis is not inevitably associated with antigliadin antibodies

Conflicts of interest: none declared. Sir, Palmoplantar pustulosis (PPP) is one of the most disabling and challenging types of psoriasis. The pathogenesis is still enigmatic.1 Earlier studies have implied an association of PPP with coeliac disease (CD) by the detection of antigliadin antibodies (AGA) in up to 25% of Swedish patients with PPP.1 Selected AGA‐positive patients with PPP have been reported to benefit from a gluten‐free diet regarding their PPP activity. The PPP reportedly even cleared in some patients by following a gluten‐free diet.1 Furthermore, an association of CD and psoriasis vulgaris has been reported.2, 3 We wondered if the incidence of IgA AGA in German patients with PPP differed from the overall incidence of IgA AGA in the German population (3–4%)4 or from that in patients with psoriasis vulgaris, and whether the incidences differed from those found in earlier studies. Thirty‐two patients (23 women and nine men; mean age 53 years) with a history of PPP exceeding 1 year and a control group of 30 patients with chronic plaque‐type psoriasis (11 women and 19 men; mean age 46 years) were included in the study. No patient had a history of CD. Twenty‐seven patients with PPP (84%) were smokers. The diagnosis was made on the clinical picture and the patients’ history. Histological and/or mycological examinations were available in several patients.