Background: Data regarding general characteristics and comorbidities of Palmoplantar pustulosis (PPP) are scarce. Objectives: To analyze the clinical features, etiologic factors, treatment, and comorbidities of PPP. Methods: We conducted a retrospective review of 262 patients with PPP. (Severance Hospital, 2006-2017) Results: More than a half of patients (70.3%) were smokers. At diagnosis, 35.1% of patients showed nail involvement and 14.9% showed arthralgia. Comorbid conditions included hypertension (HTN) in 20.9% of patients, type2 diabetes mellitus (DM) in 17.5%, and thyroid disease in 12.2%. In all, 96% received topical steroids, 17.1% received phototherapy, and 53.4% received systemic agents. In multivariate logistic regression analysis, palmoplantar distribution, nail involvement, and smoking history were significant predicting factors for the use of systemic treatment. Nail involvement, joint symptom, smoking, and thyroid disease were significant predicting factors for more recalcitrant disease represented as cases treated with more than 2 systemic therapies. Conclusion: More than half of the patients in this study had a history of smoking, which was found to be a significant determinant for more refractory course of the disease. Patients with PPP frequently presented some comorbid conditions including HTN, DM and thyroid diseases. Given this associated factors and comorbidities, thorough history taking and proper patient-education are necessary for the comprehensive care of PPP.