Palmoplantar pustulosis (PPP) remains a therapeutic challenge with limited options, and recurrence is a major issue for traditional systemic therapies and biologics. Data on long-term efficacy, safety, and relapse of Janus kinase inhibitors in PPP are limited. Drug efficacy, safety, and recurrence was retrospectively evaluated in 29 PPP patients treated with tofacitinib from January 2022 to June 2024. Disease severity and efficacy were assessed using the Palmoplantar Pustular Psoriasis Area and Severity Index (PPPASI) and Palmoplantar Pustular Psoriasis Physician's Global Assessment (PPP PGA) at baseline, week 4, and week 12, with a minimum 6-month follow-up. PPP-related haematological inflammatory indicators, including plateletcrit (PCT), pan-immune-inflammation value (PIV), neutrophil/lymphocyte ratio (NLR), and monocyte/lymphocyte ratio (MLR), were also evaluated. By week 12, mean PPPASI score significantly decreased from 18.62 to 6.17 (p < 0.001), with 72.41% achieving PPPASI-50 and 62.1% achieving PPP PGA ≤ 1. Mild adverse events (gastric discomfort) occurred in 6.9% of patients. During a mean 12.2-month follow-up, 27.6% relapsed, while 34.5% maintained clearance without medication. Disease severity-related haematologic indicators, PCT, and PIV improved significantly. Tofacitinib demonstrates significant efficacy and a favourable safety profile in PPP, warranting consideration as a therapeutic option, though larger prospective studies are needed to confirm long-term outcomes.