Background: Focal skeletal changes in patients with pustulosis palmaris et plantaris (PPP) are known to occur in a minority of patients. It is unknown whether these changes are unique events or whether they merely represent more progressed cases. Objective: The study was undertaken in order to investigate possible diffuse bone changes in patients with PPP. Methods: Bone mineral density (BMD) and biochemical markers of bone turnover were studied in 18 female patients and 18 age-matched controls. Results: A significant correlation was found between lower-forearm BMD and disease duration (< 0.05). With increasing age, patients had significantly lower values than controls for both forearm and spine BMD (p < 0.005); patients who had PPP for more than 2 years had significantly reduced forearm BMD (19.8%; 95% CI: 5.6—32.8%)) and spine BMD (17.4%; 95% CI: 0.9—33.8%). No significant differences were observed in biochemical markers of bone turnover, physical activity or body mass index between patients and controls. The proportion of smokers among patients was four times higher than among controls (p < 0.0005). No significant dose effect was found between number of pack-years and BMD. Conclusion: Although we cannot exclude that prolonged use of topical steroids under occlusion is a confounding factor, the study suggests that PPP patients have decreased BMD due to primary pathogenic events, and that osteoporosis may be an additional problem for these patients.