Plantar pustulosis (palmoplantar pustulosis when palms also involved) is a very difficult condition to treat. Topical and intralesional steroids as well as PUVA can help, but usually they need more aggressive therapy. Acitretin, and even biologics are often used. Must rule out a pustular tinea pedis. Orange arrow shows typical pustule while blue arrow shows old pustules that turn a brown/copper color, dry and desquamate.