Pustulosis Palmaris Research Articles

Anlotinib for Recurrent or Metastatic Primary Malignant Bone Tumor: A Multicenter, Single-Arm Trial.

ObjectiveAnlotinib, a novel multitarget kinase inhibitor of VEGFR, FGFR, PDGFR and c-Kit, has proven to be effective and safe for refractory soft tissue sarcoma patients, but has not been examined in recurrent or metastatic primary malignant bone tumors in a clinical trial setting.MethodsThis is a multicenter single-arm trial. Patients with pathologically proven recurrent or metastatic primary malignant bone tumors were eligible. Anlotinib was administered orally at 12 mg per day. Each cycle consisted of 2 weeks of treatment followed by 1-week off-treatment. The primary endpoint was progression-free survival (PFS), as assessed in the intention-to-treat (ITT) population. Secondary endpoints included objective response rate (ORR), disease control rate (DCR) and overall survival (OS). Adverse events (AEs) were assessed per NCI CTCAE version 4.03.ResultsA total of 42 patients were enrolled. Median PFS was 5.3 months (95% CI 3.5-8.4 months) in the overall analysis, 4.8 months (95%CI 3.5-7.1 months) in osteosarcoma patients and 2.8 months [95%CI 1.3 months to not reached (NR)] in chondrosarcoma patients. The median OS was 11.4 months (95% CI 10.1 months to NR) in the overall analysis, not reached (95% CI, NR, NR) in osteosarcoma patients and 11.4 months (95% CI 1.8 to 21.1 months) in chondrosarcoma patients. The ORR was 9.52% and DCR was 78.57%. Grade 3 or above AEs occurred in 54.76% of the patients, and included hypertension (19.05%), hypertriglyceridemia (9.52%) and pustulosis palmaris et plantaris (7.14%). No treatment-related death was reported.ConclusionAnlotinib demonstrated promising antitumor activities in recurrent or metastatic primary malignant bone tumors with manageable AEs.

Guselkumab for the treatment of palmoplantar pustulosis

ABSTRACT Introduction Palmoplantar pustulosis, or pustulosis palmaris et plantaris (PPP), is a chronic, recurrent inflammatory skin disease that is sometimes unresponsive to conventional therapy. The anti-interleukin 23 antibody guselkumab is effective for treating PPP. Areas covered This review details the current understanding of PPP and discusses why guselkumab may be effective. Guselkumab is only approved for the treatment of PPP in Japan. In the United States, Canada, the European Union, and several other countries, it is approved for the treatment of moderate-to-severe plaque psoriasis, but not for PPP. Furthermore, guselkumab was approved only 1 year ago; its efficacy will be proven only by phase 2 and 3 clinical trials. Expert opinion The first double-blinded randomized placebo-controlled trial (RCT) of guselkumab for PPP has been completed. The drug was effective, and guselkumab could be used as a new agent for PPP treatment, in addition to several conventional therapeutics. However, several issues remain. For example, there is no mouse model of PPP, so careful observation of human PPP patients and establishment of a good experimental PPP model are essential.

Clinical study of curative effect of compound Qinjiao Pill on palmoplantar pustulosis and its effect on neutrophil/lymphocyte ratio (NLR)

Objective To evaluate the efficacy of compound Qinjiao Pill in the treatment of pustulosis palmaris and plantaris and the effect on the neutrophil-to-lymphocyte ratio (NLR). Methods A total of 100 patients with palmoplantar pustulosis who met the inclusion criteria from June 2017 to June 2018 were randomly divided into two groups, 50 in each group. The control group was treated with 308 nm excimer laser twice a week, and the treatment group was treated with one compound Qinjiao Pill once and twice a day. Both groups were treated for 8 weeks and followed up for 3 months. The disease severity was evaluated by the Palmoplantar pustulosis area and severity index (PPPASI), the quality of life was evaluated by the dermatology life quality index (DLQI), the changes of serum NLR were observed, and the clinical efficacy was evaluated. Results The total effective rate was 88.0% (44/50) in the treatment group and 70.0% (35/50) in the control group. The PPPASI scores (t=6.813, 3.091, 3.582, 5.622) and DLQI scores (t=5.713, 4.616, 6.262, 1.824) in the treatment group were significantly lower than those in the control group (P<0.01). After treatment, NEU (4.13 ± 1.42 ×109/L vs. 6.56 ± 1.65 ×109/L, t=7.893), NLR (1.75 ± 0.98 vs. 2.60 ± 0.87, t=4.592). During the treatment, the incidence of adverse reactions was 20.0% (10/50) in the treatment group and 18.0% (9/50) in the control group (χ2=1.680, P=0.089). The recurrence rate of the treatment group was 9.1% (4/44) and that of the control group was 20.0% (7/35). The difference between the two groups was statistically significant (χ2=2.893, P=0.003). Conclusions Compound Qinjiao Pill combined with 308 nm excimer laser can reduce the NLR in peripheral blood, improve the clinical efficacy and reduce the risk of recurrence. Key words: Impetigo; Qinjiao Pill; Lasers, excimer; Neutrophil-to-lymphocyte ratio

抗原除去治療 ――それで治った疾患, 今後治る疾患――とくに色素沈着型化粧品皮膚炎, 掌蹠膿疱症, 化学物質誘発性SLE, アトピー性皮膚炎, そして今後は重症円形脱毛症

抗原除去治療 ――それで治った疾患, 今後治る疾患――とくに色素沈着型化粧品皮膚炎, 掌蹠膿疱症, 化学物質誘発性SLE, アトピー性皮膚炎, そして今後は重症円形脱毛症

Psoriasis

Psoriasis is an immune-mediated inflammatory cutaneous disorder characterized by chronic, scaling, erythematous patches and plaques of skin. It can begin at any age and can vary in severity. Psoriasis can manifest itself in several different forms, including pustular and erythrodermic forms. In addition to involving the skin, psoriasis frequently involves the nails, and some patients may experience inflammation of the joints (psoriatic arthritis). Because of its highly visible nature, psoriasis can compromise both the personal and the working lives of its victims. Breakthroughs in the treatment of psoriasis have led to a better understanding of its pathogenesis. This review contains 12 figures, 8 tables, and 79 references. Keywords: Psoriases, Pustulosis of Palms and Soles, Pustulosis Palmaris et Plantaris, Palmoplantaris Pustulosis, Pustular Psoriasis of Palms and Soles

Psoriasis

Psoriasis is an immune-mediated inflammatory cutaneous disorder characterized by chronic, scaling, erythematous patches and plaques of skin. It can begin at any age and can vary in severity. Psoriasis can manifest itself in several different forms, including pustular and erythrodermic forms. In addition to involving the skin, psoriasis frequently involves the nails, and some patients may experience inflammation of the joints (psoriatic arthritis). Because of its highly visible nature, psoriasis can compromise both the personal and the working lives of its victims. Breakthroughs in the treatment of psoriasis have led to a better understanding of its pathogenesis. This review contains 12 figures, 8 tables, and 79 references. Keywords: Psoriases, Pustulosis of Palms and Soles, Pustulosis Palmaris et Plantaris, Palmoplantaris Pustulosis, Pustular Psoriasis of Palms and Soles

Psoriasis

Psoriasis is an immune-mediated inflammatory cutaneous disorder characterized by chronic, scaling, erythematous patches and plaques of skin. It can begin at any age and can vary in severity. Psoriasis can manifest itself in several different forms, including pustular and erythrodermic forms. In addition to involving the skin, psoriasis frequently involves the nails, and some patients may experience inflammation of the joints (psoriatic arthritis). Because of its highly visible nature, psoriasis can compromise both the personal and the working lives of its victims. Breakthroughs in the treatment of psoriasis have led to a better understanding of its pathogenesis. This review contains 12 figures, 8 tables, and 79 references. Keywords: Psoriases, Pustulosis of Palms and Soles, Pustulosis Palmaris et Plantaris, Palmoplantaris Pustulosis, Pustular Psoriasis of Palms and Soles

Treatment outcome and prognostic factors of tonsillectomy for palmoplantar pustulosis and pustulotic arthro-osteitis: A retrospective subjective and objective quantitative analysis of 138 patients.

Pustulosis palmaris et plantaris (PPP) and pustulotic arthro-osteitis (PAO) are tonsil-related diseases. Treatment outcome of tonsillectomy and prognostic factors influencing the outcome have not been analyzed quantitatively. We evaluated those using the Palmoplantar Pustulosis Area and Severity Index (PPPASI). At 1, 3, 6, 12, 24 and more than 24 months post-tonsillectomy, 20 (31%), 34 (48%), 70 (60%), 57 (80%), 36 (95%) and 23 (96%) patients realized 80% or more improvement of PPP skin lesions, respectively, and eight (17%), 23 (36%), 30 (50%), 38 (79%), 12 (100%) and four (100%) patients showed 80% or more improvement of PPPASI (i.e. PPPASI% ≥ 80%), respectively. At 1, 3, 6, 12 and more than 12 months post-tonsillectomy, 19 (73%), 21 (66%), 27 (73%), 19 (79%) and 15 (83%) patients realized a disappearance of PAO-induced arthralgia, respectively. Kaplan-Meier analysis of 80 patients with PPP revealed that, at 12 and 24 months post-tonsillectomy, lesions disappeared (i.e. PPPASI = 0) in 38% and 66% of patients, respectively, and lesions improved by 80% or more (i.e. PPPASI% ≥ 80%) in 71% and 95% of patients, respectively. The log-rank test and univariate and multivariate analyses showed that smoking cessation post-tonsillectomy and PAO were significant predictive factors for the early disappearance of skin lesions. This report is the first demonstrating objective evidence of the great efficacy of tonsillectomy to improve PPP skin lesions. Even post-tonsillectomy, smoking inhibited the early disappearance of the lesions.

胸骨柄部体部間関節症, 肋軟骨炎(Tietze 氏病)と巣感染, 掌蹠膿疱症との関連性

胸骨柄部体部間関節症, 肋軟骨炎(Tietze 氏病)と巣感染, 掌蹠膿疱症との関連性

여성 수장족저농포증 환자 치험 3례

ABSTRACT Treatment of Female Pustulosis Palmaris et Plantaris Patients:Three Case ReportsJi-Eun Yang 1 , Ki-Hoon Lee 1 , Gyu-Tae Chang 2 1 Gangnam Dongyak Korean Medical Clinic 2 Dept. of Pediatrics. College of Koreanl Medicine, Kyung-Hee UniversityObjectives: The purpose of this study is to present three case reports on the treatments of pustulosis palmaris et plantaris patients. Methods: We administered herbal medicine to three patients who had pustu losis palmaris et plantaris and evaluated the results by Psoriasis Area and Severity Index (PASI). Results: After the treatment all three patients showed improvements in PASI. PASI of patient 1 changed from 3.6 to 0.8; patient 2 from 4.2 t o 0.8; patient 3 from 5.6 to 0.4. Conclusions: The results suggest that herbal medicine can be an effective t reatment for female pustulosis palmaris et plantaris patients. Key Words: Pustulosis palmaris et plantaris patients, psoriasis, Herbal m edicine, Skin disease, PASI 10) Corresponding author(Gyu-Tae Chang) : Dept. of Korean Pediatrics, College of Korean Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, Republic of KoreaTel : 02-440-6231 Fax : 02-440-6296 Tel : gtchang@khu.ac.kr

Detection of tumor necrosis factor-α, interleukin-17,-22 and-17F in sera from patients with palmoplantar pustulosis

Objective To determine the serum levels of tumor necrosis factor (TNF) -α, interleukin (IL) -17, IL-22 and IL-17F in patients with palmoplantar pustulosis (PP) , and to estimate their relationship with disease activity in PP. Methods Venous blood samples were collected from 30 patients with PP at both active stage and stationary stage and from 20 healthy human controls. Enzyme-linked immunosorbent assay (ELISA) was conducted to determine the serum levels of TNF-α, IL-17, IL-22 and IL-17F. The paired Wilcoxon signed rank test was carried out to compare the serum levels of cytokines between patients at active stage and at stationary stage, and the Mann-Whitney U test to compare those among different groups. Results The median serum levels of TNF-α, IL-17 and IL-22 in patients with PP at active stage were 186.35 (range, 113.48-412.69) ng/L, 420.45 (range, 278.55-748.73) ng/L and 106.48 (range, 69.13-251.86) ng/L respectively, significantly higher than those at stationary stage (42.52 (18.83-95.37) ng/L, 48.11 (36.43-80.04) ng/L, 20.32 (10.55-48.75) ng/L, respectively, all P 0.05). Conclusion The circulating levels of TNF-α, IL-17 and IL-22 were associated with disease activity in PP, hinting that they may be involved in the development of PP. Key words: Psoriasis; Tumor necrosis factor-alpha; Interleukin-17; Interleukins; Pustulosis palmaris et plantaris; Interleukin-22; Interleukin-17F

Analysis of Patients Visiting Niigata University Medical and Dental Hospital with Chief Complaints of Metal Allergy and/or Focal Infection in the Previous 8 Years

Dental metal allergy and dental focal infection are possible causes of dermatological diseases, but have been the subjects of few reports to date. We have been treating such patients in our special clinic for more than 20 years.The purpose of the present study was to investigate the mouths of patients visiting our dental hospital over an 8-year period, with the aim of clarifying whether dental metal allergy and/or dental focal infection affects their dermatologic conditions.We surveyed all clinical records of the 185 patients who visited Niigata University Medical and Dental Hospital with chief complaints of dental metal allergy since 2002. Diagnostics of skin diseases, periodontal records, periapical lesions, dental caries, dental metal series patch test results and Electron Probed Micro-Analysis (EPMA) data were investigated. Ninety-two (49%) patients were suffering from pustulosis palmaris et plantaris and 20 (11%) patients had lichen planus. Eighty-two (49%) patients showed positive reactions on patch testing. Based on the result of patch tests, Ni showed the highest positivity rate (62%, 51 patients), but on EPMA, the number of patients with Ni as an allergen was 14 (27%). On the other hand, more than 98% of patients who showed positive reactions on patch test to Pd and Au had these metals in their dental prostheses. In addition, 112 (60%) patients showed the possibility of dental focal infections

A Statistical Analysis of 111 Cases of Pustulosis Palmaris et Plantaris during the Past 3 Years

A Statistical Analysis of 111 Cases of Pustulosis Palmaris et Plantaris during the Past 3 Years

수장족저외 병변을 겸한 수장족저농포증 치험 1례

Objective : The purpose of this study is to report the Korean medicine treatment on Pustulosis Palmaris et Plataris with Extra-Palmoplantar lesions. Method : We adopted herbal medicine(Seungchung-tang-1, Eunjin-1), acupuncture and vapor treatment to treat Pustulosis Palmaris et Plantaris with Extra-Palmoplantar lesions. Steroids were administered for preventing aggravation. We observed patient's hot sensation, itching and pain of both hands and patient's itching and pain of both feet with the Visual Analogue scale(VAS). Also photographs were taken for judging inflammatory skin. Result : After the treatment, the grade of VAS was decreased from 10 to 0 and clinical symptoms were resolved. By judging photographs patient's inflammatory skin was cured. Administered steroid were also reduced from 15 mg per day to 0. Conclusion : This study shows that the Korean medicine treatment was effective to treat Pustulosis Palmaris et Plataris with Extra-Palmoplantar lesions and enable to stop steroid therapy.

Vesicular LL-37 contributes to inflammation of the lesional skin of palmoplantar pustulosis.

“Pustulosis palmaris et plantaris”, or palmoplantar pustulosis (PPP), is a chronic pustular dermatitis characterized by intraepidermal palmoplantar pustules. Although early stage vesicles (preceding the pustular phase) formed in the acrosyringium contain the antimicrobial peptides cathelicidin (hCAP-18/LL-37) and dermcidin, the details of hCAP-18/LL-37 expression in such vesicles remain unclear. The principal aim of the present study was to clarify the manner of hCAP-18/LL-37 expression in PPP vesicles and to determine whether this material contributed to subsequent inflammation of lesional skin. PPP vesicle fluid (PPP-VF) induced the expression of mRNAs encoding IL-17C, IL-8, IL-1α, and IL-1β in living skin equivalents, but the level of only IL-8 mRNA decreased significantly upon stimulation of PPP vesicle with depletion of endogenous hCAP-18/LL-37 by affinity chromatography (dep-PPP-VF). Semi-quantitative dot-blot analysis revealed higher concentrations of hCAP-18/LL-37 in PPP-VF compared to healthy sweat (2.87±0.93 µM vs. 0.09±0.09 µM). This concentration of hCAP-18/LL-37 in PPP-VF could upregulate expression of IL-17C, IL-8, IL-1α, and IL-1β at both the mRNA and protein levels. Recombinant hCAP-18 was incubated with dep-PPP-VF. Proteinase 3, which converts hCAP-18 to the active form (LL-37), was present in PPP-VF. Histopathological and immunohistochemical examination revealed that early stage vesicles contained many mononuclear cells but no polymorphonuclear cells, and the mononuclear cells were CD68-positive. The epidermis surrounding the vesicle expresses monocyte chemotactic chemokine, CCL2. In conclusion, PPP-VF contains the proteinase required for LL-37 processing and also may directly upregulate IL-8 in lesional keratinocytes, in turn contributing to the subsequent inflammation of PPP lesional skin.

수족농포증에 목초액 사용 후 발생한 자극 피부염 치험 1례

Abstract Objectives : The purpose of this study is to report the oriental treatment on Irritant Dermatitis Caused by Wood Vinegar on Pustulosis Palmaris et Plantaris. Methods : After using Wood Vinegar, a patient suffers from erythema, pruritus, pain, desquamation of skin and degeneration of Pustulosis Palmaris et Plantaris. The patie nt was admitted to Dunsan oriental hospital for 15 days and took an oriental(venesection, herbal-medicine, and vapor treatment) treatment. To evaluate the results of this treatment, the improvement of symptoms(vesicles, pruritus, pain) was identified by patient's subjective expression and in lesion-symptom improvement. Results : The symptoms caused by Wood vinegar on both palms and soles were improved but the desquamation of skin remained. Conclusions : This study shows that the oriental medical treatment effects on the irritant dermatitis caused by Wood Vinegar. Also, the public should be aware of indiscreetly- used, natural herbal products as a folk remedy.Key words ; Irritant dermatitis, Wood Vinegar, Side effect, Pustulosis P almaris et plantaris

수장족저농포증 치험 1례

Objectives : The aim of this study is to assess change of the skin and quality of life of the Pustulosis Palmaris et Plantari patient by Traditional Korean Medicine. Methods : We used Bihaesamsp-tanggagambang and herbal medication for external use. The progress is evaluated by Dermatology Life Quality Index (DLQI), and the patient gave marks about the subjective symptoms from 0 to 4 Results : Through the treatment, Dermatology Life Quality Index (DLQI) changed from 29 to 22, and sub jective symptoms of both itching and burning sensation changed from 4 to 1. Conclusions : Traditional Korean Medicine seems to be effective for the Pustulosis Palmaris et Plantari treatment. More clinical cases and studies are needed to develop an organized therapeutic measures

Presence of keratin-specific antibody-forming cells in palatine tonsils of patients with pustulosis palmaris et plantaris (PPP) and its correlation with prognosis after tonsillectomy

Conclusion: Keratin-specific immune responses in tonsils may be associated with the pathogenesis of pustulosis palmaris et plantaris (PPP). Evaluation of keratin-specific immune responses in tonsils might be useful to predict the effectiveness of tonsillectomy for patients with PPP. Objectives: The aim of the present study was to clarify the role of keratin-specific immune responses in the pathogenesis of PPP in tonsils. It has been reported that anti-keratin antibodies in serum were higher in patients with PPP and decreased after tonsillectomy, indicating that anti-keratin antibodies might be generated in tonsils. Methods: In order to demonstrate the presence of keratin-specific immune responses in tonsils, the numbers of keratin-specific antibody-forming cells (AFCs) in tonsillar and peripheral blood lymphocytes were examined by enzyme-linked immunospot assay. The prognosis of PPP was compared after tonsillectomy. Results: The numbers of keratin-specific IgM and IgG AFCs in tonsils and of IgG AFCs in peripheral blood were significantly increased in patients with PPP. The numbers of keratin-specific IgG AFCs in peripheral blood correlated positively with tonsil and serum IgG antibodies specific to keratin. Our data show that a good prognosis in patients with PPP depended on the numbers of keratin-specific IgG and IgM AFCs in peripheral blood and the levels of keratin-specific IgG antibodies in serum being significantly decreased 6 months after tonsillectomy.

Over-expression of kallikrein related peptidases in palmoplantar pustulosis

Pustulosis palmaris et plantaris or palmoplantar pustulosis (PPP) is a chronic pustular dermatitis characterized by palmoplantar intraepidermal vesicles filled with neutrophils. That very early vesicle formation occurs in the acrosyringium, and the sweat antimicrobial peptides, hCAP-18/LL-37 and dermcidin, are present in the vesicles of the palms and soles was discovered recently [1]. Also, IL-17 positive cell infiltration around the acrosyringium as well as IL-17 expression in the acrosyringeal cells has been reported [2].

Patients with palmoplantar pustulosis have increased IL-17 and IL-22 levels both in the lesion and serum

Recent findings about the pathogenesis of pustulosis palmaris et plantaris (PPP), also known as palmoplantar pustulosis, suggest that IL-17 expression in the acrosyringium as well as infiltration of IL-17 positive cells, e.g. Langerhans cells may play important roles. However, to date, it has not been established whether circulating IL-17 related cytokines are involved in PPP. We studied the circulating IL-17 related cytokines as well as the mRNA levels in lesional skin. IL-17 related cytokine mRNAs were increased in the PPP lesions compared with the control tissues (five patients vs five controls). The serum levels of TNF-alpha, IL-17, IL-22 and IFN-gamma also were significantly increased in PPP, but not IL-23 and IL-8 (48 patients vs 20 controls). Our findings document that not only the serum IL-17 but also tissue IL-17 are elevated in PPP and may be in the pathogenesis of this disorder.