Takahara M, et al. - Experts assessed treatment outcome of tonsillectomy and prognostic factors influencing the outcome of tonsillectomy for palmoplantar pustulosis and pustulotic arthro-osteitis using the Palmoplantar Pustulosis Area and Severity Index (PPPASI). For the early disappearance of skin lesions, significant predictive factors were smoking cessation post-tonsillectomy and pustulotic arthro-osteitis (PAO) as demonstrated by the log-rank test and univariate and multivariate analyses. The objective evidence of efficacy of tonsillectomy to improve PPP skin lesions was demonstrated in this study for the first time. The early disappearance of the lesions was inhibited by smoking even post-tonsillectomy.