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Palmoplantar pustulosis (PPP) is a chronic relapsing inflammatory disease of unknown aetiology characterized by erythema, scaling, and aseptic pustules, which pose a significant clinical, psychological, and economic burden to patients. Studies have shown that the tonsils play a key role in the exacerbation and pathogenesis of certain diseases. This paper systematically summarizes the evidence supporting the close association between tonsils and PPP, and proposes mechanisms by which tonsils may contribute to the pathogenesis of PPP. In addition, the paper elucidates the role of tonsillectomy in alleviating PPP, provides a basis for considering it as a treatment option after conventional PPP treatment has failed, and lays the groundwork for an in-depth investigation of the intricate relationship between tonsillectomy and PPP.