S.A.P.H.O. syndrome is characterized by the association, even not simultaneous, of osteoarticular and cutaneous manifestations. This review has the purpose to clear up some features of clinical manifestations and the osteo-articular involvement. Articular mainly feature is the involvement of anterior chest wall, that begins with slow evolving pain. Skin involvement is characterized by acne conglobata and pustolosis palmaris-plantaris. Instrumental investigations that fit better for studying the anterior chest wall, complex region, are bone scintigraphy, computed tomography and nuclear magnetic resonance, with their domain pattern. Symptomatic therapy are mostly represented by NSAIDs, but still opiate drugs can be prescribed; corticosteroids have variable and unforeseeable efficacy. Bisphosfonates are usually utilized due to their anti-osteoclastic effects. Finally, because of documented incremented production of TNFalpha, TNFalpha blocking agents should be effectively utilized.