Palmoplantar Psoriasis Research Articles

A Case of Palmoplantar Psoriasis Successfully Treated with Apremilast

A Case of Palmoplantar Psoriasis Successfully Treated with Apremilast

2089 Psoriasis Induced by Infliximab Treatment in a Young Patient With Crohn’s Disease

INTRODUCTION: Now that Infliximab has been used more frequently for treatment of multiple autoimmune diseases including IBD, side effect profile of infliximab has increasingly been seen in clinical practice. One of the rare side effect is induction of psoriasis with infliximab though paradoxically it has been used as a treatment in psoriasis. We present a case of young female with Crohn’s who developed palmoplantar psoriasis while on infliximab. CASE DESCRIPTION/METHODS: 30 Y/O female with history of Crohn’s s/p ileocecectomy (diagnosed in 2016 and subsequently lost to follow up), presented to GI clinic for ongoing diarrhea and abdominal pain for 2 months. She underwent elective colonoscopy which showed typical Crohn's appearance with endoscopic Rutgeerts Score of I3. She was started on infliximab and azathioprine after pretreatment testing. Three months into the treatment, she developed a new papular rash limited to her palms and soles which progressed to dry, erythematous rash with sloughing. She was diagnosed of drug induced psoriasis by dermatology and was started on topical petroleum based therapies and oral steroids. She showed no improvement in next few weeks and in fact, developed a new scalp rash. At this point, decision was made to stop Infliximab and start her on Stelara. Her rash started improving significantly after making this change and her bowel symptoms continued to be well controlled as well. DISCUSSION: TNF alpha inhibitors are currently the mainstay therapy for treatment of moderate to severe Crohn’s disease. TNF-a induced psoriasis is a major challenge for treating clinician. Prevalence of Psoriasiform lesions range from 1.7 to 35% in different studies. Its mechanism of action is unclear but it could be due to unopposed production of Interferon-A caused by TNF-a inhibitors as IFN-a is a well known trigger for development of psoriasiform lesions. First step in management includes topical therapies and oral steroids directed at controlling skin disease. If this fails, some studies suggest use of another TNF-a inhibitor though there is cross reactivity among different members of the class. Availability of Interleukin 12/23 inhibitors like Ustekinumab (Stelara) is an excellent alternative for such Crohn’s patients as it is also approved for psoriasis. We used this strategy in our patient who showed clinical improvement very quickly. There is certainly need of further analysis and studies to understand long term consequences of this approach as experience is still insufficient on this.

A comparative clinical study of classical and non-classical Siravyadha in Vipadika

In Ayurveda all the skin diseases are described under single heading i.e. ‘Kushta’ which are further divided into Mahakushta and Kshudrakushta. Vipadika is among the 11 types of Kshudra Kushta involving Vata Kapha mentioned in classics characterized by ‘Panipada Sphutana’ (Fissures in Palms and Soles) and ‘Tivravedana’ (Severe Pain). On basis of its signs and symptoms it can be correlated with ‘Palmoplantar Psoriasis’. Kushtachikitsa is classified into Shodhanam, Shamanam and Nidanparivarjana amongst which Shodhana Chikitsa is of greater significance in skin diseases, and Raktamokshana is considered to be a shortest and effective treatment in the management of skin diseases. Siravyadha is a type of Panchashodhana described by Acharya’s as an effective remedy in number of disease conditions. Acharya Sushruta and Vagbhata has mentioned that Siravyadha is half treatment in Shalyatantra as Basti is the half treatment in Kayachikitsa. Diseases which do not get pacified so quickly by therapeutic measures like Snehana, Swedana etc. are pacified by Siravyadha.

Real-world data for evaluating effectiveness and safety of secukinumab in the treatment of scalp and palmoplantar psoriasis in adults with moderate-to-severe skin disease

Real-world data for evaluating effectiveness and safety of secukinumab in the treatment of scalp and palmoplantar psoriasis in adults with moderate-to-severe skin disease

Experience with secukinumab in the treatment of palmoplantar pustular psoriasis: Analysis of 6 cases

Experience with secukinumab in the treatment of palmoplantar pustular psoriasis: Analysis of 6 cases

Acute onset of psoriatic spondyloarthritis as a new manifestation of post-streptococcal reactive arthritis: a case series

Streptococcus is well associated with a myriad of inflammatory diseases. Among others, this bacterium is linked to the triggering of psoriasis and to post-streptococcal reactive arthritis (PSRA), an arthritis which is typically confined to peripheral joints. Three patients who developed acute psoriatic spondyloarthritis (SpA) following a recent streptococcal infection are described in this article. We searched the existing literature for cases of axial involvement in PSRA and reviewed the association between streptococcal infection and psoriasis or psoriatic arthritis )PsA). In all patients, psoriatic SpA occurred within 7-10days of a confirmed streptococcal infection. The main presenting syndrome was inflammatory back pain with evidence of acute axial spondyloarthritis on magnetic resonance imaging. One patient had guttate psoriasis, the second patient developed pustular psoriasis, and the third patient had exacerbation of pustular palmoplantar psoriasis. Two patients required treatment with tumor necrosis factor alpha (TNF-α) blockers. Axial involvement in PSRA is very rare. A potential association of streptococcal infection and development of PsA has been explored in several articles. However, to the best of our knowledge, acute psoriatic SpA as a manifestation of PSRA has yet to be described. Acute psoriatic SpA should be considered in the differential diagnosis of new-onset inflammatory back pain followed by psoriasis in young adults who had a recent throat infection. KEY POINTS: • Our case series describes three cases of acute psoriatic spondyloarthritis that occurred within 7--10 days of a confirmed streptococcal infection and progressed to full blown chronic disease. • Acute psoriatic spondyloarthritis as a manifestation of post streptococcal reactive arthritis should be considered in the differential diagnosis of new onset inflammatory back pain followed by psoriasis in young adults who had a recent throat infection.

Assessment of efficacy of methotrexate and acitretin in the management of psoriasis

Background: Psoriasis is a chronic inflammatory skin disease characterized by a prominent T-cell infiltrate, epidermal hyper proliferation and abnormal keratinocyte differentiation. The present study was conducted to assess efficacy of methotrexate and acitretin in the management of psoriasis.Materials & Methods: 72 patients diagnosed with palmoplantar psoriasis were divided into 2 groups of 36 each. Group I patients were prescribed oral methotrexate15mg/week for 3 months and group II were given oral acitretin 0.5 mg/kg daily for 3 months. Modified psoriasis area severity index (MPASI) score was assessed.Results: There were 16 males and 20 females in group I and 18 males and 18 females in group II. The mean MASI score at baseline, 1 month, 2 months and 3 months was 58.2, 38.4, 23.2 and 14.6 and 60.4, 40.2, 30.5 and 20.4 in group I and II respectively. The difference was significant (P

Efficacy of short-term naturopathy and yoga interventions on palmoplantar psoriasis

Psoriasis is a chronic inflammatory disease, associated with a higher risk of cardiovascular, metabolic, and renal disease, and patients may experience significant impairment of health-related quality of life even with localized disease. According to a study conducted on 3065 patients, plantar lesions were seen in 91.9% of patients and palmar lesions in 55.6% of patients. Our patient is a 47-year-old married man, with a history of erythema, scaling, itching pain often associated with bleeding on the affected area of both palms and soles since 6 months. After obtaining informed consent, he was admitted to our inpatient Department of Government Yoga and Naturopathy Hospital. Since naturopathic interventions aimed to put right the lifestyle improvement, he underwent treatments such as neutral enema, mud therapy, diet therapy, acupuncture, and yoga therapy at our inpatient department (IPD). Considering the basic principle of naturopathy, i.e., accumulation of morbid matter, one of the main causes of disease has been taken into an account for planning the line of treatment. Pre-blood investigations include resting blood pressure, pulse rate, respiratory rate, fasting blood glucose level, and serum cholesterol level. The patient was asked to fill the Psoriatic Area and Severity Index (PASI) was used as a tool to measure the severity of the lesions and the area affected. Pre- and post-assessments were done using PASI. Immediately after 2 days of intervention, the pain and the itching in the affected area was subsided, and after 15 days of intervention, our patient was provided with exclusive juice diet with 6 servings per day. After 20 days of intervention, the PASI Scoring was reduced from 8.8 to 2. A 20-day naturopathic intervention has shown clinically significant change in the severity of psoriatic lesions in our case.

Long-term continuation with secukinumab in psoriasis: association with patient profile and initial psoriasis clearance.

There are limited data regarding the long-term continuation with biological therapy for patients with psoriasis. In particular, the reasons for secukinumab discontinuation have not been thoroughly investigated. To better ascertain the real-life continuation of secukinumab in psoriasis, we conducted a retrospective study to evaluate the incidence, causes and factors of secukinumab discontinuation in patients with psoriasis. All patients treated with secukinumab for psoriasis in the Department of Dermatology (Toulouse University and Larrey Hospital, Toulouse, France), between September 2011 and June 2017, were enrolled in the study. Of the 91 patients in the study, 22 (24.2%) discontinued secukinumab. In 14 (15%) patients, the discontinuation was due to loss of efficacy. Two patients stopped treatment because they planned a pregnancy and five patients stopped because of adverse events. A longer disease duration (P=0.01) and presence of palmoplantar psoriasis (P=0.01) seem to be predictive factors for treatment failure. Patients reaching 90 or 100% improvement in Psoriasis Area and Severity Index (PASI90 and PASI100, respectively) at weeks 12-16 had a lower risk of long-term treatment discontinuation compared with patients who had less complete clearance (P=0.04). Long-term persistence of secukinumab appears to be good, as only 24.2% (n=22) of the patients in this study discontinued secukinumab over the follow-up period. Loss of efficacy prompted discontinuation in about 14% of patients by the 2-year follow-up. Persistence appears to be lower in patients with palmoplantar psoriasis and in patients previously exposed to many systemic treatments. Optimal therapeutic response at 12-16weeks as defined by reaching PASI90-100 seems to be predictive of long-term treatment persistence.

Position Statement on Secukinumab in the Management of Plaque Psoriasis: The Malaysian Perspective.

Psoriasis is a chronic inflammatory skin disease affecting nearly 10% of dermatologic patients in Malaysia. Treatment options include topical agents and phototherapy as well as nonbiologic and biologic systemic therapy. Mild psoriasis can often be managed with topical agents. However, managing moderate to severe psoriasis is more challenging and may require systemic treatment with nonbiologics or biologics. Despite the availability of several biologics, there are many unmet clinical needs, which may be addressed by secukinumab, an IL-17A inhibitor. This position statement is based on an expert panel discussion and is intended to provide dermatologists an overview of existing options as well as to provide a better understanding of secukinumab and how it can be integrated into current practice. During the discussion, panel members examined current approaches and the role of secukinumab in plaque psoriasis management. Panel members estimated that up to 30% of patients have moderate to severe psoriasis but only 1-2% receive biologics. Highlights from the discussion were that (i) the threshold for biologic use should be lower, in line with international guidelines; (ii) studies have shown that secukinumab has several advantages over other biologics which are greater efficacy, sustained efficacy over time, rapid onset of action, and early evidence of possible disease-modifying potential; and (iii) ideal candidates for secukinumab are all patients of moderate to severe psoriasis, including those with history of treatment failure, difficult-to-treat patterns of psoriasis (nail, scalp, and palmoplantar psoriasis), psoriatic arthritis, and comorbidities and those aiming for clear skin. Panel members recommend that secukinumab be considered first line option among biologic therapies.

A retrospective study on palmoplantar psoriasis and its associations in a tertiary care centre

<p class="abstract"><strong>Background:</strong> Psoriasis is a chronic immune mediated inflammatory condition of the skin. Palmoplantar psoriasis (PPP) is a clinical variant of plaque psoriasis affecting palms and soles extending to the wrist and the margins of the soles and heels. This study was done to find out the prevalence of palmoplantar psoriasis in our setting. The aim of the study was to determine the prevalence, demographic features and other co-morbidities of the palmoplantar plaque psoriasis in a tertiary care centre.</p><p class="abstract"><strong>Methods:</strong> We conducted retrospective study for a period of one year (January 2017 to December 2017) on palmoplantar plaque psoriasis patients attending the dermatology OPD.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 552 enrolled psoriasis patients, 85 were clinically diagnosed to have palmoplantar psoriasis. The mean age of the patient was 45 years. Most of them belong to 4<sup>th</sup>, 5<sup>th </sup>and 6<sup>th</sup> decade of life. The male to female ratio was 1:2.26. The duration of the disease was more than one year in 73% of patients at the study time. Occupation of the patients included house-wives (50%), manual labourers (36%) and office goers, (13%). Hyperkeratotic plaque type psoriasis with scaling and fissures was the predominant morphological pattern recorded. Dyslipidemia (22%), overweight and obesity (56%), hypothyroidism (6%) and diabetes mellitus (12%) were the observed co-morbidities in this study.</p><p class="abstract"><strong>Conclusions:</strong> The prevalence of palmoplantar psoriasis (0.09%) was low in our study. Palmoplantar psoriasis affected middle aged adults and had a female predominance in this study. Overweight, obesity, dyslipidemia, diabetes mellitus and hypothyroidism were the co-morbid conditions observed in this study. Being a relapsing and chronic condition the disease poses a poor quality of life than plaque type psoriasis.</p>

Management of recalcitrant palmoplantar psoriasis

Management of recalcitrant palmoplantar psoriasis and palmoplantar pustular psoriasis continues to be a challenge. Standardized therapeutic guidelines are not available due to limited data. The recalcitrant nature points to the need for systemic therapy but a trial with topical therapy is needed before planning systemic therapy. Among the topical therapies available topical steroids or combination of topical steroids with calcipotriol are the most effective. Light-based therapies are effective modalities in patients who do not respond to topical therapy. Systemic therapy is indicated in non-responders. Acitretin, methotrexate and cyclosporine are widely used. There are increasing data on the use of biologicals in non-responders to systemic immunomodulators, but the cost is a deterrent. The biologic agents include etanercept, infliximab, adalimumab, ustekinumab, secukinumab, apremilast and others. Traditional therapies such as phototherapy, acitretin or methotrexate are often preferred over newer antitumor necrosis factor (TNF) agents for patients with comorbid conditions due to the immunosuppressive effects of TNF-α inhibitors and concern about paradoxical exacerbation of disease in some patients.

The efficacy and safety of targeted narrowband UVB therapy: a retrospective cohort study

Background/aim Phototherapy is a safe and effective treatment modality for numerous dermatological conditions. Recently, targeted phototherapy modalities have gained importance due to their advantages over conventional phototherapy. This retrospective study aimed to evaluate the safety and efficacy of targeted narrowband UVB phototherapy in patients with dermatological disorders.Materials and methods This single-center study included 173 patients who were treated with targeted narrowband UVB phototherapy. Demographic features, phototherapy parameters, and adverse effects were evaluated in all patients, and the treatment response was assessed in patients who attended at least one follow-up visit. Results A total of 173 patients (102 females; 71 males) with vitiligo, alopecia areata, lichen simplex chronicus, palmoplantar psoriasis, and psoriasis vulgaris were included in the study. Among 73 patients, with whom the treatment was finalized by physician, an excellent response was obtained in 10%, 52.9%, 53.8%, 28.6%, and 40% of patients with vitiligo, alopecia areata, lichen simplex chronicus, palmoplantar psoriasis, and psoriasis, respectively. The treatment was generally well tolerated and was discontinued in only two patients due to adverse effects.Conclusion This study demonstrates that targeted narrowband UVB therapy is a safe and effective treatment alternative, particularly for alopecia areata, lichen simplex chronicus, and palmoplantar and plaque-type psoriasis.

Management of Vipadika through Ayurveda

Vipadika,is one of the types of the Kshudrakushtha. There is involvement of Vata-Kaphadosha predominantly. It is characterized by PaniPadasphutna (fissure in palms and soles) and Tivravedana (severe local pain).Vipadika can be correlated with Palmo plantar psoriasis due to its similarity in clinical features. It is found in 3-4 % of all psoriasis cases. Here is a case of chronic vipadika. She came to kayachikitsa OPD on 02/03/2017 .She had history of consumption of continous medication since one year from modern medicine and homoeopathy. After clinical examination ,she was admitted in MGAMCH & RC for 7 days and was treated with Yoga basti, oral medications and external applications. After discharge, she had prescribed medicines for oral and external application for 30 days. There was complete relief in fissure and pain and she has no recurrence upto the month of January 2019.

Secukinumab for moderate-to-severe palmoplantar pustular psoriasis: Results of the 2PRECISE study

Palmoplantar pustular psoriasis (PPP) is a debilitating disease of the palms and/or soles that is resistant to treatment. Secukinumab, an anti-interleukin 17A monoclonal antibody, is highly efficacious in the treatment of moderate-to-severe psoriasis. The primary objective was to determine the rate of achievement of a 75% improvement from baseline in Palmoplantar Psoriasis Area and Severity Index (PPPASI75) with secukinumab at week 16 versus with placebo (at a 2.5% significance level). 2PRECISE was a phase 3b multicenter, randomized, double-blind, placebo-controlled, parallel-group study comparing treatment with 300mg of secukinumab (n=79), 150mg of secukinumab (n=80), and placebo (n=78) in subjects with moderate-to-severe PPP over a period of 52weeks. The primary end point was not met. At week 16, 26.6% of subjects treated with 300mg of secukinumab achieved PPPASI75 versus 14.1% of those who received placebo (P=.0411) (odds ratio, 2.62; 95% confidence interval, 1.04-6.60). At week 52, 41.8% of subjects treated with 300mg of secukinumab had achieved ppPASI75.More Dermatology Life Quality Index responses of 0 or 1 were achieved with 300mg of secukinumab (13.0%) than with placebo (4.3%) at week 16. At week 52, 43.1% of subjects receiving 300mg of secukinumab hadaDermatology Life Quality Index response of 0 or 1. No unexpected adverse events were observed. Small sample size and characteristics of the PPP disease course. Patients with PPP who were treated with secukinumab, 300mg, showed benefit in terms of PPPASI75 responses over 52weeks and improved quality of life.

Comparative therapeutic evaluation of 308 nm monochromatic excimer light in combination with calcipotriol ointment vs 308 nm monochromatic excimer light alone in palmoplantar psoriasis

<p class="abstract"><strong>Background:</strong> Palmoplantar psoriasis is difficult to treat and often recalcitrant to traditional treatment modalities like topical steroids, anthralin, calcipotriol, methotrexate, cyclosporine, NB-UVB and PUVA. This study was aimed to compare efficacy of 308 nm monochromatic excimer light (MEL) in combination with calcipotriol ointment to 308 nm MEL alone in treatment of palmoplantar psoriasis.</p><p class="abstract"><strong>Methods:</strong> This self-control study was conducted in 30 patients of palmoplantar psoriasis. Right side was treated with 308 nm MEL, 2 times/week, at meantime calcipotriol ointment was applied externally, 2 times/day (treatment group); the left side was treated with 308 nm MEL alone, 2 times/week (control group). Erythema, scaling, induration and fissuring (ESIF) score and cumulative doses of 308 nm MEL were assessed before treatment and on weeks 2, 4 and 6 after initiation of treatment.<strong></strong></p><p class="abstract"><strong>Results:</strong> All 30 patients completed the treatment. ESIF scores on week 2, week 4, and week 6 in treatment group were significantly lower than control group (p<0.01). The average cumulative MEL dose in treatment group at the end of trial was 8.12±1.72 J/cm<sup>2</sup>, which was significantly lower than in control group 12.76±1.92 J/cm<sup>2</sup> (p<0.01).</p><p class="abstract"><strong>Conclusions:</strong> Treatment of palmoplantar psoriasis with 308 nm MEL in combination with external application of calcipotriol ointment can improve long-term treatment efficacy, decrease cumulative doses, and adverse effects induced by MEL irradiations.</p>

Management of Vipadika (Palmoplantar Psoriasis) with Ayurveda - A Case Study

Vipadika is explained under the context of Kshudra Kushta. The symptoms are correlated with palmoplantar psoriasis. Vatakaphadosha predominantly involved in this disease. It is characterized by Panipadasphutana and Teevravedana. Here is a case of 8 year old child with history of cracks in foot with pealing and discoloration, pain, itching and occasional bleeding since 3 years. Patient was treated with Vatakaphahara treatment with Sneha and Sweda and Veshtana Chikitsa for 1 week and Shamana Oushadis for 15 days. Patient had good relief in symptoms.

Clinical Characteristics of Japanese Patients with Palmoplantar Pustulosis.

Palmoplantar pustulosis (PPP) is a chronic inflammatory disorder characterized by sterile pustules predominantly involving the palms and soles. The purpose of this review was to describe the characteristics of Japanese PPP patients as PPP is frequently observed within the Japanese population. Most Japanese dermatologists consider PPP a distinct entity, and co-existence of PPP and psoriasis is rare; however, outside Japan, PPP is often considered to be palmoplantar psoriasis, and an extra-palmoplantar lesion associated with PPP is considered to be psoriasis. PPP frequently develops or exacerbates following focal infections such as tonsillitis, odontogenic infection, and sinusitis, either with or without arthralgia. Pustulotic arthro-osteitis (PAO) is a major comorbidity of PPP, most often affecting the anterior chest wall. In Japanese patients, PAO is frequently seen, whereas cases of SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome with symptoms other than PPP and sternocostoclavicular joint pain are extremely rare. A difference in incidence depending on race suggests that different genetic backgrounds may be responsible for susceptibility to these disorders. The treatment of focal infections often results in dramatic effects on cutaneous lesions, as well as joint pain. The characteristics of Japanese patients with PPP are female predominance, mostly smokers, rare co-existence with psoriasis, frequent association with PAO, almost no accompanying celiac disease, and closely associated with focal infection. PPP should be separately considered from palmoplantar psoriasis.

Paradoxical reversed plantar involvement during ixekizumab therapy for psoriasis

Palmoplantar psoriasis is a particularly challenging variant of psoriasis. Psoriasis at this location has a significant impact on health-related quality of life and is often recalcitrant. However, difficult cases may respond to biologic therapies. Paradoxical reactions during treatment with biological agents have been described, mostly during anti-tumor necrosis factor therapy. These typically present as a change in morphology or distribution of lesions. We present a patient with palmoplantar psoriasis treated with ixekizumab who achieved a favorable response that was coupled with a rare paradoxical reaction, reversed plantar involvement. The reason for this phenomenon and its clinical course are uncertain, but these new lesions are proving recalcitrant to complementary therapies. Provided the increasingly widespread use of biologic therapies, the incidence and diversity of paradoxical reactions are expected to increase.

How frequently does palmoplantar psoriasis affect the palms and/or soles? A systematic review and meta-analysis.

IntroductionPalmoplantar psoriasis (PPP) is a variant of psoriasis that affects the palms and/or soles. Although PPP is a disabling and therapeutically challenging condition, its epidemiology is poorly defined.AimTo assess the prevalence of PPP locations (palms, soles or both), and to analyse epidemiological and clinical characteristics of the disease.Material and methodsTwo bibliographic databases (MEDLINE and SCOPUS) were used as data sources searched from inception to October 2017. The selection of articles was limited to human subjects and English or French languages.ResultsA search resulted in a total of 293 articles, out of which 24 were utilized for the current systematic review and 21 for meta-analysis. All listed studies comprised a total of 2083 patients with PPP, with more males than females. According to the results of meta-analysis, majority of patients had the highest prevalence of both palms and soles involvement (95% CI: 47–67), with an almost equal prevalence showing palmar (21%; 95% CI: 13–30) or plantar (20%; 95% CI: 12–29) involvement. The most prevalent type of PPP was plaque/hyperkeratotic, followed by the pustular type.ConclusionsAlmost three-fifths (59%) of all PPP patients had involvement of both palms and soles, while exclusive palmar or plantar involvement was seen in 21% and 20% of patients, respectively. Future research should be performed to elucidate basic epidemiological and clinical characteristics of PPP, which would be helpful for proper consideration of this condition.