The palmoplantar skin reacts monotonously to acute causes with vesicles or pustules and to chronic or chronically recurrent noxae with hyperkeratosis. Vesicular reactions are mostly triggered by eczematogens and fungi. Among the primary pustuloses, pustular psoriasis of the palms and soles is the dominating one, while the secondary pustuloses stem from infections of vesicular reactions with pyogens. Hyperkeratotic reactions may be caused directly by mechanical irritations or dehydration of the skin but also secondarily by chronic or chronically recurrent vesicular and pustular reactions.