Palmoplantar Psoriasis Research Articles

Real‐world effectiveness and safety of apremilast in psoriasis at 52 weeks: a retrospective, observational, multicentre study by the Spanish Psoriasis Group

Little has been published on the real-world effectiveness and safety of apremilast in psoriasis. To evaluate the effectiveness, safety and drug survival of apremilast at 52weeks in patients with moderate to severe plaque psoriasis or palmoplantar psoriasis in routine clinical practice. Retrospective, multicentre study of adult patients with moderate to severe plaque psoriasis or palmoplantar psoriasis treated with apremilast from March 2016 to March 2018. We studied 292 patients with plaque psoriasis and 85 patients with palmoplantar psoriasis. The mean (SD) Psoriasis Area and Severity Index (PASI) score was 10.7 (7.0) at baseline and 3.0 (4.2) at 52weeks. After 12months of treatment, 73.6% of patients had a PASI score of 3 or less. In terms of relative improvement by week 52, 49.7% of patients achieved PASI-75 (≥75% reduction in PASI score) and 26.5% achieved PASI-90. The mean physician global assessment score for palmoplantar psoriasis fell from 4.2 (5.2) at baseline to 1.3 (1.3) at week 52. Overall drug survival after 1year of treatment with apremilast was 54.9 %. The main reasons for treatment discontinuation were loss of efficacy (23.9%) and adverse events (15.9%). Almost half of the patients in our series (47%) experienced at least one adverse event. The most common events were gastrointestinal problems. Apremilast may be a suitable alternative for the treatment of moderate to severe psoriasis and palmoplantar psoriasis. Although the drug has a good safety profile, adverse gastrointestinal effects are common.

Apremilast for psoriasis treatment.

Apremilast is a small-molecule inhibitor of phosphodiesterase 4 with an intracellular mechanism of action that increases levels of cyclic adenosine monophosphate (cAMP) indicated for the oral treatment of moderate to severe plaque psoriasis and for the treatment of psoriatic arthritis. Efficacy of apremilast in moderate-to-severe psoriasis has been demonstrated in the pivotal trials, with a 30% PASI-75 response rate at week 16, an efficacy that was maintained through week 52. Apremilast also achieved significant responses in disease involving specific sites, such as palmoplantar, nail and scalp psoriasis, improved patient quality of life, and achieved rapid improvements in pruritus. The findings of some of the real world series indicate that the PASI-75 response may be higher in patients with a lower baseline PASI than that observed in the pivotal trials, enhancing the importance of using the absolute PASI score as a marker of therapeutic success rather than a relative PASI index in this setting. Apremilast has demonstrated good safety and tolerability in both clinical trials and clinical practice series. The most frequent adverse effects were diarrhea (17.3%), nausea (15.7%), upper respiratory tract infections (15.5%), nasopharyngitis (14.4%), tension headache (9.0%) and headache (6.3%). The rate of adverse events recorded in the clinical practice series has been lower compared to the clinical trials.

Efficacy of oral methotrexate (MTX) monotherapy vs oral MTX plus narrowband ultraviolet light B phototherapy in palmoplantar psoriasis.

Palmoplantar psoriasis (PPP) is a chronic, inflammatory dermatosis of the palms and/or soles with significant morbidity. It is notoriously difficult to treat and unresponsive to traditional topical agents. We aim to compare the effect of oral methotrexate (MTX) monotherapy vs MTX plus narrowband ultraviolet light B (NB-UVB) in the treatment of recalcitrant PPP. This was a comparative clinical trial involving 90 patients of PPP. Eligible patients were randomly assigned to one of the two treatment groups. We aim patients in group A received 10 mg oral MTX weekly, and patients in group B received oral MTX 10 mg weekly and NB-UVB sessions twice weekly for 12 weeks. There was a statistically significant difference in reduction of modified PPP Area Severity Index (m-PPPASI) of patients in MTX plus NB-UVB at week 12. The mean m-PPPASI at week 12 was 3.66 ± 2.11 in MTX plus NB-UVB group and 6.51 ± 2.04 in MTX only group (P < .001). Marked improvement (m-PPPASI 75) was achieved in 20 (44.44%) patients in MTX plus NB-UVB group compared with 6 (13.3%) in MTX monotherapy group (P < .001). Combination of MTX and NB-UVB phototherapy helps to attain a better clinical response (reduction in m-PPPASI score) than MTX monotherapy in the treatment of recalcitrant PPP.

Paradoxical Skin Reaction to Certolizumab, an Overlap of Pyoderma Gangrenosum and Psoriasis in a Young Woman Treated for Ankylosing Spondylitis: Case Report with Literature Review.

IntroductionBiologic agents form an indispensable part of modern therapeutic regimens for the treatment of severe inflammatory diseases, especially in the fields of rheumatology, dermatology and gastroenterology. They are favoured by both physicians and patients due to their high effectiveness, good patient tolerance and safety. However, interference in the regulation and dynamics of inflammatory cytokines can on occasion lead to an onset of a dermatological condition also known as paradoxical skin reaction. Here, we present a case of paradoxical skin reaction induced by certolizumab.Case ReportA young woman with ankylosing spondylitis developed a severe and complex cutaneous reaction after 6 months of otherwise successful treatment with certolizumab. The diagnosis of a rare paradoxical cutaneous reaction post anti-tumour necrosis factor alpha treatment was based on overlapping features of pyoderma gangrenosum and palmoplantar pustular psoriasis. Alopecia developed and there was also nail involvement. Treatment proved to be challenging as the disease did not remit after the patient ceased treatment with certolizumab. The patient was started on a combination of secukinumab and methotrexate to control the symptoms, with a promising outcome.ConclusionParadoxical skin reactions are an emerging clinical entity that require further research in order to establish risk factors and best personalized treatment.

Efficacy and safety of adalimumab in difficult-to-treat psoriasis.

Psoriasis is a chronic immune-mediated inflammatory skin disorder, with a prevalence of 2% to 3% worldwide. Psoriatic lesions affecting scalp, nails, palms, and soles are considered difficult-to-treat and require specific management. When psoriasis involves these areas, it may be considered more severe even if the lesions are not extensive. Adalimumab (Humira) is a fully human monoclonal antibody against tumor necrosis factor (TNF), administered via subcutaneous injection. It has already been used in the treatment of adults and children with moderate-to-severe chronic plaque psoriasis. In literature, few studies investigated its efficacy in difficult-to-treat areas, hence we conducted an observational prospective study of 24 weeks to assess its role in patients with difficult to treat psoriasis. We found out a significant improvement in nail and scalp psoriasis, while palmoplantar and genital psoriasis showed an improvement though not statistically significant. Therefore, adalimumab can be used in difficult-to-treat areas with great results, also allowing an improvement in the quality of life of affected patients, both adults and children.

Clinical aspects of palmoplantar dermatoses in patients attending tertiary health care centre

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Dermatoses affecting palms and soles are among the most difficult of all dermatological therapeutic problems. Apart from diagnostic difficulties, few palmoplantar dermatoses cause great discomfort and disability and may also affect a person's livelihood. To evaluate demographic aspects like age and gender wise distribution and clinical profile of patients suffering from palmoplantar dermatoses.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This cross-sectional study was conducted between August 2018 to July 2019 in the Department of Dermatology, venereology and leprosy in tertiary care centre. Total 200 cases attending the department of dermatology primarily with complaints pertaining to palms and soles with or without body part involvement in patients of age group between 5-70 yrs. and both sexes were enrolled in the study. Investigations such as direct microscopic examination of scrapings, wet mount with potassium hydroxide, Wood’s lamp examination, patch testing and sample for biopsy was taken. After taking consent a detailed history and clinical examination pertaining to the aim of the study was recorded and analysed.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 200 patients were enrolled, among which 63% were males and 37% were females showing male predominance. The most common age group affected was 21-40 years. The most common chief complaint was itching (41.5%). Palmoplantar psoriasis was the most common dermatosis with 23.5% cases.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Palmoplantar dermatoses are frequently encountered in the dermatologic field. Early recognition of clinical symptoms and signs aids in diagnostic investigations and helps in appropriate and effective management of illness to improve the quality of life.&lt;/p&gt;

A case report of palmoplantar psoriasis treated with homeopathic Secale cornutum

A case report of palmoplantar psoriasis treated with homeopathic Secale cornutum

A study of the drug secukinumab in the treatment of palmoplantar psoriasis

Palmoplantar psoriasis is a chronic (long term) and difficult‐to‐treat form of psoriasis that affects the palms of the hands and the soles of the feet. The disease causes reddish, scaly plaques on the palms and/or soles with or without the presence of such scales elsewhere on the body. Since palms and soles are affected, the patient can have serious issues in carrying out tasks of daily life such as walking, bathing and eating. This can lead to severe disturbance of their quality of life, and such patients may withdraw socially or suffer from depression and lack of confidence. A drug called secukinumab has been shown to offer rapid and long‐lasting effectiveness in treating patients with plaque psoriasis (psoriasis with scales on back, trunk, hands and legs); however, its effect on palmoplantar psoriasis had not been exclusively studied. A randomized control trial is a type of clinical trial in which patients are randomly assigned to a treatment group, and there is also a control group who do not receive any of the treatments being studied. GESTURE, the largest and longest duration randomized controlled study, was conducted to assess the efficacy and safety of secukinumab in people with palmoplantar psoriasis. Both the immediate (16 weeks) and long‐term (2.5 years) results were evaluated. Treatment with secukinumab resulted in quick improvements (starting as early as Week 2) in these patients and the Week 16 results proved the efficacy of secukinumab in palmoplantar psoriasis. The patients were further treated and followed‐up until 2.5 years to understand if the effects are continued or if the disease returns (known as relapse). The 2.5‐year results confirmed that secukinumab treatment resulted in long‐lasting effectiveness in patients with palmoplantar psoriasis. Patients experienced improved hand and feet functioning and therefore improved quality of life. No safety issues were identified. This is a summary of the study: Sustained efficacy of secukinumab in patients with moderate‐to‐severe palmoplantar psoriasis: 2.5‐year results from GESTURE, a randomized, double‐blind, placebo‐controlled trial

Characterization of Patients with Psoriasis in Challenging-to-Treat Body Areas in the Corrona Psoriasis Registry

Background: Real-world studies evaluating patients with challenging-to-treat localizations of psoriasis (scalp, nail, and palmoplantar) are limited. Objective: To characterize patients with versus without psoriasis in challenging-to-treat areas seen in routine US clinical practice. Methods: This retrospective observational study included all adult patients with psoriasis enrolled in the Corrona Psoriasis Registry between April 2015 and May 2018 who initiated a biologic therapy at registry enrollment. Patients were stratified by the presence of scalp, nail, or palmoplantar psoriasis (nonmutually exclusive groups). Patient demographics, clinical char­acteristics, disease activity, and patient-reported outcome measures (pain, fatigue, itch, EuroQol visual analog scale [EQ VAS], Dermatology Life Quality Index [DLQI], and Work Productivity and Activity Impairment questionnaire [WPAI]) were assessed at registry enrollment and compared between patients with versus without each challenging-to-treat area using nonparametric Kruskal-Wallis tests for continuous variables and χ² or Fisher exact tests for categorical variables. Generalized linear regression models were used to estimate differences in disease activity and patient-reported outcomes between patients with versus without each challenging-to-treat area. Results: Among 2,042 patients with psoriasis (mean age [±SD], 49.6 ± 14.7 years; 51.5% male), 38.4% had psoriatic arthritis (PsA), 38.1% had scalp psoriasis, 16.0% had nail psoriasis, 10.9% had palmoplantar psoriasis, and 26.2% had a combination of ≥2 challenging-to-treat areas and PsA; only 34.2% had body plaque psoriasis without PsA or challenging-to-treat areas. Patients in all challenging-to-treat groups reported higher (mean [95% CI]) itch (scalp, 58.01 [57.62–58.40] vs. 54.35 [53.99–54.72]; nail, 56.42 [56.02–56.81] vs. 55.59 [55.20–55.97]; palmoplantar, 60.22 [59.86–60.59] vs. 55.15 [54.79–55.54]) and lower EQ VAS (scalp, 68.12 [67.78–68.48] vs. 69.46 [69.12–69.81]; nail, 66.21 [65.89–66.55] vs. 69.48 [69.14–69.83]; palmoplantar, 66.21 [66.07–66.75] vs. 69.29 [68.94–69.94]) scores than those without the respective challenging-to-treat localization. Patients with nail or palmoplantar psoriasis reported higher pain, fatigue, and DLQI scores than those without. Higher proportions of patients with scalp or palmoplantar psoriasis reported work impairment compared with those without. Conclusion: Two-thirds of patients with psoriasis who initiated biologic therapy had PsA and/or ≥1 challenging-to-treat area. Patients with challenging-to-treat areas had worse patient-reported outcome scores than those without, indicating a significant burden of challenging-to-treat areas on patients’ quality of life.

Interventions for chronic palmoplantar pustulosis.

Interventions for chronic palmoplantar pustulosis.

Iontophoretic delivery of methotrexate in the treatment of palmar psoriasis: A randomised controlled study.

Palmoplantar psoriasis is a localised variant of psoriasis. Topical therapy is the preferred treatment modality, but in severe and recalcitrant cases, systemic drugs like methotrexate are prescribed, with potential for significant adverse effects. Iontophoresis is gaining popularity in enhancing the transdermal delivery of drugs in ionic state. This study was undertaken to evaluate and compare the efficacy of topical methotrexate by iontophoresis technique with clobetasol propionate 0.05% ointment in the treatment of palmar psoriasis. This was a prospective randomised controlled study conducted on patients with palmar psoriasis. Group 1 patients (n=31) were treated with once weekly iontophoretic delivery of methotrexate over 6 sittings, and group 2 patients (n=31) were treated with clobetasol propionate 0.05% ointment, twice daily for 6weeks. Severity of palmar psoriasis was assessed by modified Palmoplantar Pustular Psoriasis Area and Severity Index (m-PPPASI), and treatment was considered as satisfactory when there was >50% improvement. Sixty two patients were recruited, of which 50 completed the study. Eight out of 25 (32%) patients in group 1 and 12 out of 25 (48%) patients in group 2 showed satisfactory improvement at the end of 6weeks. However, this difference was statistically not significant (P=0.25). Burn injury was noted in 12 (48%) group 1 patients with no adverse effects in group 2. Iontophoretic delivery of methotrexate is a promising therapeutic modality, the efficacy of which is comparable to that of clobetasol propionate ointment in the treatment of palmar psoriasis.

Chronic palmoplantar psoriasis management through Ayurveda: A case study

Psoriasis is a chronic inflammatory skin ailment described by thickened, silvery-scaled patches. It has been related with inflammatory and immune mechanisms, probably associated with a genetic predisposition that can be triggered by stress. Psoriasis can badly influence the quality of life of patients. Various medicines are available, which may permit transient improvement and long-haul control of the sickness; however, these measures do not completely cure psoriasis. This study reports the case of a 58-year-old married male patient who presented at the skin outpatient department (OPD), All India Institute of Ayurveda, with severe palmoplantar psoriasis (PPP), and had been managed with Ayurveda medicines and three times of Virechana Karma (medicated purgation) along with control diet and yoga since the last 16 months. After adherence to prescribed treatment for the last 16 months, the patient responded with complete resolution of psoriatic patches on his body. The efficacy of treatment was measured by “Psoriasis Area and Severity Index (PASI)” scale. Total two assessments were carried out before starting Ayurveda treatment and after completion of 16 months of treatment based on the scoring of PASI, and it was found that the score reduced by 95.5%, from 9.1 to 0.4. Virechana Karma (medicated purgation) is very effective in providing relief in the signs and symptoms of chronic PPP. Hence, it may be concluded that classical Ayurveda measures are helpful to the patients with chronic PPP to achieve complete cure. Present findings can only be generalized when large sample study is undertaken.

Effect of an Ayurveda treatment in palmoplantar psoriasis: A case study

Psoriasis is an immune-mediated disease characterized by chronic inflammatory changes in the skin. Around 5% of all the psoriasis sufferers have palmoplantar psoriasis, which is challenging to treat a variety of psoriasis. Ayurveda is rich in herbs having proven anti-psoriatic action. However, the complex and multifactorial pathogenesis of psoriasis needs a multimodal treatment approach. In the present case report, a 45-year-old female patient presented with soles of feet partially covered, thickened, red skin having sharp, and noticeable borders demarking the psoriasis patches from unaffected skin. There were painful cracks over the soles and thickened erythematous plaques on the right elbow. Clinical examination revealed the involvement of Tridosha (~three biological humors) in the Samprapti (~pathophysiology). The multimodal treatment including Patolakaturohinyadi kashaya, Kaishora guggulu, Mahatiktaka ghrita, Gandhaka rasayana, and Khadirarishta as internal medicines, whereas Winsoria oil and Panchavalkala kwatha as external medicines showed promising results. Within six months of the treatment, the psoriatic lesions and associated signs and symptoms healed effectively. Altogether, multimodal Ayurveda treatment can be an effective and safe solution for palmoplantar psoriasis.

Widespread pustular eruption following probiotic use

A 26-year-old woman with Crohn disease and palmoplantar psoriasis on ustekinumab presented with a diffuse and intensely pruritic rash with a few pin-point pustules within days after initiation of an over-the-counter Align brand probiotic. Biopsy revealed psoriasiform and spongiotic dermatitis with spongiform subcorneal pustules and scattered eosinophils, consistent with acute generalized exanthematous pustulosis. Our case highlights a unique presentation of acute generalized exanthematous pustulosis following probiotic exposure with fewer than usual pustular lesions. IL23 suppression by ustekinumab may have contributed to the patient's reduced pustular presentation.

Use of a new cold plasma tool for psoriasis treatment: A case report

Cold atmospheric plasma sources are emerging as new potent tools in different fields of medicine, from oncology to dermatology. Psoriasis is a chronic inflammatory disease characterized by the presence of itchy red plaque on skin, known as psoriatic plaques. In this case report, we evaluate the effectiveness of a cold atmospheric plasma treatment on a psoriatic plaque on the hand of a 20-year-old woman. Two quick applications of the procedure led to a complete disappearance of the cutaneous lesion in 14 days. The results of this case show a potential application of this new technique in the dermatological field, as palmo-plantar psoriasis is usually resistant to traditional treatments. A clinical trial would be necessary in order to evaluate the real effectiveness of this plasma.

Adverse Events Leading to Discontinuation of Phototherapy: An Observational Study.

The aim of this prospective study in a phototherapy unit was to describe adverse events (AEs) associated with discontinuation of phototherapy in a clinical setting. A total of 872 included patients received 1,256 courses of phototherapy treatment: 76.9% narrowband UVB (NBUVB); 9.6% systemic psoralen plus UVA (PUVA); 11.4% topical PUVA; and 2.1% UVA. Approximately a fifth of the treatments (n = 240, 19.1%) were associated with AEs, the most frequent of which was erythema (8.8%). Systemic PUVA had the highest rate of AEs (32.5%). Mycosis fungoides was the dermatosis with the highest rate of AE (36.9%). A total of 216 (17.2%) patients stopped treatment: 23.6% because of AEs (4.1% of all treatments). Treatment suspension due to AEs was associated with PUVA, both topical and systemic (p < 0.001), and diagnoses of mycosis fungoides (p < 0.001), palmoplantar psoriasis (p = 0.002), hand eczema (p = 0.002) and pityriasis lichenoides (p = 0.01). In conclusion, one in every 5 patients receiving phototherapy had an AE, but few stopped treatment for this reason.

Pustular Psoriasis: The Dawn of a New Era.

Pustular psoriasis is a clinically heterogeneous entity of different, orphan disease subtypes, among which the most clearly defined are generalized pustular psoriasis, palmoplantar psoriasis, and acrodermatitis continua of Hallopeau. Although phenotypically and genetically distinct from psoriasis vulgaris, these subtypes may be associated with plaque psoriasis lesions, establishing the rationale for their inclusion in the psoriasis spectrum. Unlike psoriasis, however, their genetic background is thought to be mainly monogenic, as shown by the recent identification of mutations in 3 different genes of the skin innate immune system; IL36RN, CARD14 and AP1S3. These major advances in the understanding of the disease pathogenesis have led to the design and ongoing development of tailored therapeutic approaches, which are highly necessary given the refractory nature of pustular psoriasis in response to most available antipsoriatic drugs.

Palmoplantar Psoriasis Successfully Treated with Raw Natural Honey: A Case Report

Palmoplantar Psoriasis Successfully Treated with Raw Natural Honey: A Case Report

Lack of association between mutation in IL36RN and palmoplantar pustular psoriasis in Chinese patients

BackgroundPalmoplantar pustulosis is considered to be a localized pustular psoriasis confined to the palms and soles. Mutation of the IL36RN gene, encoding interleukin-36 receptor antagonist (IL-36Ra), is associated with generalized pustular psoriasis, but IL36RN mutations in Chinese palmoplantar pustulosis patients have not previously been investigated. ObjectiveThe aim of this study was to evaluate the mutation of IL36RN in Chinese patients with palmoplantar pustulosis. MethodsFifty-one Han Chinese patients with palmoplantar pustulosis were recruited. All exons and exon-intron boundary sequences of IL36RN were amplified in polymerase chain reactions, and Sanger sequencing of the amplicons was performed. ResultsAmong the 51 palmoplantar pustulosis patients, four different single-base substitutions were identified in nine patients. The mutations were c.140A>G/p.Asn47Ser in five patients, c.258G>A/p.Met86IIe in two patients, and c.115+6T>C and c.169G>A/p.Val57IIe in one patient each. All mutations were heterozygous. Comparison with the human genome database and reported literature suggested that these variants may not be pathogenic mutations causing palmoplantar pustulosis. Furthermore, there was no difference in disease severity, onset age, or disease duration between patients with these heterozygous IL36RN variants and those without (p>0.1). Study limitationLack of the further evaluation of IL36Ra protein in palmoplantar pustulosis lesions. ConclusionsThe four variants of IL36RN identified did not appear to be associated with the specific phenotypes of palmoplantar pustulosis.

Palmoplantar psoriasis: a comparative therapeutic study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Psoriasis is an immunologically mediated inflammatory dermatosis presenting with extremely variable clinical manifestations ranging from indolent lesions to life threatening forms of pustular and erythrodermic psoriasis. Palmoplantar psoriasis present as hyperkeratotic scaly plaques with fissures and can be managed with different treatment forms. This study was done to compare the efficacy between topical and systemic treatment options.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was conducted in a tertiary level teaching hospital after ethical committee clearance. Fifty patients with palmoplantar psoriasis were allocated into the two groups using simple random sampling. PPPASI scoring was calculated to assess the extent of involvement. Patients in Group A were prescribed calcipotriol with clobetasol propionate ointment. Group B patients were given tablet methotrexate.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Twenty eight patients were males M: F of 1.27: 1. Mean age was 36. Mean duration of illness was eleven months. Most of these patients were manual laborers. 32 patients had lesions over both palms and soles, 9 over palms alone and 9 involving soles alone. Mean PASI reduction at 16 weeks was seen maximum with methotrexate. Compliance was comparatively good with methotrexate than topical. Though mean PASI reduction and compliance was good, relapse rates were higher with methotrexate in our study.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There was no significant change in clinico-epidemiology and presentation of palmoplantar psoriasis. Methotrexate was observed to be the more efficacious modality in treating palmoplantar psoriasis.&lt;/p&gt;