Treatment Of Palmoplantar Psoriasis Research Articles

Comparison of the clinical efficacy of topical tretinoin 0.05% cream and tacrolimus 0.1% ointment plus iontophoresis in the management of palmoplantar psoriasis.

Palmoplantar psoriasis (PPP) is a localized variant of psoriasis that may be resistant to topical therapy, owing to the poor penetrability of topical agents at this anatomical site. Modalities that enhance localized cutaneous delivery of drugs could help to solve this problem. Iontophoresis is one such procedure that augments transdermal drug delivery, thus enabling better and expeditious therapeutic outcomes. To compare the therapeutic efficacy and safety of iontophoresis with tretinoin 0.05% cream and tacrolimus 0.1% ointment in treating patients with PPP. Sixty patients with PPP (28 males and 32 females, age range 8-76 years) were enrolled and randomly assigned to one of two groups comprising 30 patients each. One group (12 males and 18 females) received iontophoresis with tretinoin 0.05% cream; the other (16males and 14 females) received iontophoresis treatment with tacrolimus 0.1% ointment. Both groups received treatment weekly from baseline until 4 weeks and then fortnightly at weeks 6 and 8. Clinical images were taken at each visit and improvement of psoriasis was evaluated using the erythema, scaling, induration and fissuring (ESIF) score. The percentage reduction in ESIF score was also assessed on completion of treatment and the grade of improvement noted for each patient. Twenty-seven patients in the iontophoresis with tretinoin 0.05% cream group and 29 in the iontophoresis treatment with tacrolimus 0.1% ointment group completed the study. The mean (SD) ESIF score in the former decreased significantly from 8.7 (2) at baseline to 3.2 (1.7) at the study endpoint (P < 0.001). Similarly, in the latter group, there was a substantial reduction in mean (SD) ESIF score from 8.2 (1.9) at baseline to 3.3 (1.1) at the study end (P < 0.001). No significant adverse effects were encountered in either treatment arm. Iontophoresis using tretinoin and tacrolimus was found to be effective and safe for the treatment of PPP. Although iontophoresis with tretinoin showed slightly better results than with tacrolimus, these were not statistically significant.

Drug survival of biologics and non-biologics in patientsaffected by palmoplantar psoriasis: a "real-world", mono-center experience.

Data on the treatment of palmoplantar psoriasis (PP) are very limited as these patients are often excluded from clinical trials. Moreover, this form of psoriasis is often resistant to treatment, making its clinical management complex. Primary endpoint was to evaluate the clinical and demographic characteristics and the drug survival of both biological and non-biological drugs in a population affected by PP. Secondary endpoint was to highlight any differences between the hyperkeratotic and pustular variant. We analyzed data from 233 psoriasis patients with palmoplantar involvement, with or without chronic plaque psoriasis. We performed a drug-survival analysis with the aid of Kaplan-Meier survival and a multivariate analysis to highlight the influence of certain variables on treatment persistence using a Cox regression model. The drug-survival analysis revealed that biologic drugs compared to non-biologic drugs are associated with a higher persistence in treatment (59.73 vs. 43.56%); in particular, anti-IL23 drugs were found to be the drugs with the best drug-survival overall (67.94% of patients at 60 months are still on these drugs). Furthermore, our multivariate analysis shows that when compared with biological drugs, non-biological drugs are associated with an increased risk of treatment discontinuation (HR = 1.95 [95% CI: 1.41-2.68], P = 0.001). Our study confirms the difficulty of treating PP and shows that biologic drugs are associated with longer persistence in treatment than non-biologics in both PP's variants, not because of their higher effectiveness but because of their better safety profile.

Comparative study of topical 0.1% tazarotene cream versus calcipotriol 0.005% ointment in the treatment of palmoplantar psoriasis

Palmoplantar psoriasis is classified into two types based on morphology- hyperkeratotic palmoplantar psoriasis and pustular palmoplantar psoriasis. Hyperkeratotic palmoplantar psoriasis presents with well defined erythematous scaly plaques with overlying hyperkeratosis without the presence of sterile pustules, predominantly at the palms and/or soles. There is greater physical and functional disability in patients of palmoplantar psoriasis. Patients with palmoplantar disease are more likely to suffer from a significant impact on skin-related QoL, have problems with activities of daily living, and rely on topical prescription medications than patients with moderate-to-severe plaque psoriasis. These differences are important while creating therapeutic strategies and in understanding patients’ expectations of the treatment. Objective: To compare the clinical efficacy and study the adverse effects of topical 0.1% tazarotene cream and 0.005% calcipotriol ointment in the treatment of palmoplantar psoriasis.A total of 82 palmoplantar psoriasis cases who attended the OPD of a tertiary care hospital in Northern India for a period of two years formed the study group. The study group was randomized into Group A and Group B. Group A participants were instructed to apply a liquid paraffin-based emollient in night, followed by 0.1 % tazarotene cream under occlusion for 12 weeks. Group B patients were instructed to apply calcipotriol ointment 0.005% twice daily on lesions and a liquid-paraffin based emollient in night daily for 12 weeks. The response to treatment was evaluated by improvement in PPPASI at 2-week interval up to 12 weeks.At 12 weeks of follow-up 42.9% patients showed an excellent response, 31.4% showed a clear response in group A. In group B 25% patients had an excellent response and 10% patients showed complete clearance. Adverse effects were seen more in group A.Topical treatment modalities for palmoplantar psoriasis are effective and have a low risk for adverse effects. Both topical calcipotriol 0.005% and tazarotene 0.1% cream are effective in the treatment of palmoplantar psoriasis. While topical tazarotene 0.1% cream showed an excellent clinical response among patients, it was associated commonly with adverse effects such as local irritation and itching in initial weeks of the treatment. Usage of topical 0.005% calcipotriol ointment showed a good clinical response among the patients, with mild side effects of local irritation and itching which resolved on subsequent treatment.

Effectiveness of risankizumab in the treatment of palmoplantar psoriasis: a 52-week Italian real-life experience.

Data on the treatment of palmoplantar psoriasis (PP) are scarce, representing a therapeutic challenge. This study aims to assess the efficacy and safety of risankizumab in a population of patients with psoriasis with a palmoplantar involvement, over a 52-week treatment period. We performed a retrospective analysis in a cohort of patients with PP, with or without involvement of other skin sites. Palmoplantar Psoriasis Area and Severity Index (ppPASI) was assessed at baseline and after 4, 16, 28 and 52 weeks, to evaluate the PP severity. Sixteen patients were enrolled. The rates of ppPASI90 responses constantly increased during the period of observation and were 18.7%, 62.2%, 75.0% and 81.2% at weeks 4, 16, 28 and 52, respectively. Only two patients suspended treatment because of ineffectiveness at week 16. Our data from a series of 16 patients reveal that risankizumab could represent an effective and safe therapeutic choice in patients with PP.

33385 A polymeric emulsion of halobetasol propionate and tazarotene in the treatment of palmoplantar psoriasis

Palmoplantar psoriasis is related to a significantly decreased quality of life compared with generalized psoriasis. However, therapeutic guidelines for palmoplantar psoriasis have not been established due to limited data. Topical treatment is typically the first-line recommendation, but it is often ineffective in palmoplantar psoriasis, as standard preparations do not adequately penetrate the thickened stratum corneum of the palms and soles. A novel polymeric emulsion lotion with a fixed combination of corticosteroid halobetasol propionate 0.01% and retinoid tazarotene 0.045% (HP/TAZ) may overcome this challenge, as it has demonstrated increased dermal penetration compared with conventional preparations of either ingredient.

Secukinumab is effective in the treatment of recalcitrant palmoplantar psoriasis and palmoplantar pustular psoriasis in a daily practice setting

Secukinumab is effective in the treatment of recalcitrant palmoplantar psoriasis and palmoplantar pustular psoriasis in a daily practice setting

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.

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

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

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; 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.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 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.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 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&amp;lt;0.01). The average cumulative MEL dose in treatment group at the end of trial was 8.12±1.72 J/cm&lt;sup&gt;2&lt;/sup&gt;, which was significantly lower than in control group 12.76±1.92 J/cm&lt;sup&gt;2&lt;/sup&gt; (p&amp;lt;0.01).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; 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.&lt;/p&gt;

Apremilast in Combination With an Interleukin 17A Inhibitor in the Treatment of Recalcitrant Palmoplantar Psoriasis

Background: Palmoplantar psoriasis (PPP) is a chronic, immune-mediated, inflammatory disorder affecting the palms and soles. Despite marked improvement in patient outcomes with use of biologic therapies, PPP remains hard to treat as the efficacy of systemic agents does not fully carry over to PPP trials. Methods: The study was approved by the institutional review board of Tufts Medical Center. It is a retrospective chart review of patients seen in Tufts Medical Center’s dermatology outpatient clinic who met the criteria of being diagnosed with PPP and received an anti-interleukin 17 A (IL-17A) concurrently with apremilast for a period of no less than 12 weeks. Four patients who met the criteria were included in the study, and descriptive analysis was performed due to the small sample size. Results: All 4 patients analyzed showed improvement in Palmoplantar Physician Global Assessment (PPPGA) while on combination apremilast and anti-IL17A therapy. Prior to anti-IL17A therapy, the first 3 patients had baseline PPPGAs of mild to severe. They then had PPPGAs of moderate while on anti-IL17A therapy and PPPGAs of clear/almost clear while on the combination of anti-IL17A therapy and apremilast. Patient 4 had a PPPGA of almost clear while on adalimumab, methotrexate, and acitretin and a PPPGA of clear after treatment with ixekizumab, apremilast, and methotrexate. Minimal side effects were reported on combination treatment. Conclusion: All 4 patients who were treated with combination anti-IL17A and apremilast achieved a PPPGA of clear or almost clear. Although the sample size is small, these encouraging results merit further investigation into combination therapy in the treatment of recalcitrant PPP.

Apremilast, an oral phosphodiesterase 4 inhibitor, in the treatment of palmoplantar psoriasis. Our experience in real clinical practice

Apremilast, an oral phosphodiesterase 4 inhibitor, in the treatment of palmoplantar psoriasis. Our experience in real clinical practice

Apitherapy as a New Approach in Treatment of Palmoplantar Psoriasis.

BACKGROUND:Apitherapy is the medical use of honey bee products, “honey, propolis, royal jelly, bee wax, and bee venom to relieve human ailments. Propolis is one of the most well-documented products derived from the honeybee and has always played an important role in traditional folk medicine.AIM:The aim was to justify the consideration of Aloe Vera as an effective remedy for the treatment of psoriasis.METHODS:The study follows (857) patients (354 females, 503 males) with a mean age range from (9 - 62) years, affected with moderate to severe psoriasis in palms and foot soles treated by a combination mixture of propolis and Aloe in the form of an ointment (Aloreed) and Beauty reed cream. The treatment duration was for 12 weeks. Results were evaluated by using clinical, histological and statistical parameters.RESULTS:After the 12 - week treatment, we observed an 86% overall response rate from which 62% showed excellent results and 24% showed good results, therefore proving the efficiency in the use of the mixture of propolis 50% and aloe vera 3% as topically applied ointment in the treatment of mild to moderate psoriasisCONCLUSION:Patients who have palmoplantar psoriasis, who were treated with a topically applied mixture of propolis (50%) and aloe vera (3%), have shown noteworthy improvement thus proving the efficiency of propolis and aloe vera in the treatment of mild to moderate psoriasis.

The Efficacy of Biologic Therapy for the Management of Palmoplantar Psoriasis and Palmoplantar Pustulosis: A Systematic Review.

IntroductionPalmoplantar psoriasis (PP) and palmoplantar pustulosis (PPP) are diseases affecting the hands and/or feet that can cause marked physical discomfort and functional disability. The tumor necrosis factor-alpha antagonists adalimumab, etanercept, and infliximab, the interleukin (IL)-17A inhibitors ixekizumab and secukinumab, and the IL-23 or IL-12/IL-23 inhibitors guselkumab and ustekinumab have been well studied for the treatment of moderate to severe plaque psoriasis. Less is known about the efficacy and safety of these agents for the treatment of PP (hyperkeratotic and pustular forms) and PPP. The aim of this review was to investigate the efficacy of biologic therapy for the treatment of hyperkeratotic PP, pustular PP, and PPP.MethodsA systematic search of the medical electronic databases (Medline, Embase, and Cochrane Library) was conducted to identify studies or case reports which both used biologic therapy for the treatment of hyperkeratotic PP, pustular PP, and PPP and reported treatment outcomes.ResultsThe systematic search identified 579 published articles, of which 44 were included in the analysis. Seven of the articles involved randomized placebo-controlled trials, two were open label trials, and the remaining were cohort studies, case series, or case reports. In the randomized controlled trials on the treatment of hyperkeratotic PP, adalimumab, guselkumab, infliximab, ixekizumab, and secukinumab each demonstrated superiority to placebo at 16, 16, 14, 12, and 12 or 16 weeks, respectively (p < 0.05). For the treatment of pustular PP, ustekinumab 45 mg was not superior to placebo at 12 and 16 weeks, respectively (p > 0.05), although an open label study demonstrated that four of five patients on a therapeutic regimen of ustekinumab 90 mg achieved clinical clearance at 16 weeks. For the treatment of PPP, etanercept and ustekinumab 45 mg were not superior to placebo at 12 and 16 weeks, respectively (p > 0.05). A combined analysis of studies for hyperkeratotic PP demonstrated that 94.7%, 90.0%, 82.5%, 89.1%, and 86.7% of patients experienced an improvement of at least 50% upon treatment with adalimumab, guselkumab, ixekizumab, secukinumab, and ustekinumab, respectively. In a combined analysis of case reports examining PPP, infliximab showed the greatest efficacy at 100.0% clinical improvement of patients from case reports, followed by ustekinumab at 58.8% clinical improvement. Few serious adverse events were reported, but several were reported in patients treated with infliximab or secukinumab.ConclusionBiologic therapy is effective and well-tolerated for the treatment of hyperkeratotic PP, but less data are available on the treatment of pustular PP or PPP. Adalimumab, guselkumab, ixekizumab, secukinumab, and ustekinumab all showed > 80% efficacy for the treatment of hyperkeratotic PP, while infliximab and ustekinumab showed moderate efficacy for the treatment of pustular PP, and infliximab was the most efficacious treatment for PPP.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-017-0207-0) contains supplementary material, which is available to authorized users.

English

BACKGROUND: Psoriasis is a common genetically determined chronic inflammatory skin disease. It is characterized by well defined erythematous plaque with silvery white scales. It is commonly distributed over the elbow, knee, lower back, nails, scalp, palms and soles. It is associated with varying periods of remission and relapse. Various modalities of treatment have been tried. The main goal of therapy is rapid control of the disease and to maintain a longer duration of remission. Treatment of palmoplantar psoriasis and remission maintenance is very difficult. AIM OF THE STUDY: The aim of the study is to compare the efficacy of topical psoralen and ultraviolet A phototherapy with sequential therapy of topical 0.05% clobetasol propionate ointment and topical 0.005% calcipotriol ointment in palmoplantar psoriasis and to observe the adverse effects, remission maintenance and PASI percentage reduction of more than 50% in both groups. MATERIALS AND METHODS: 50 patients are included in the study. The population for the study included patients attending outpatient Department of Dermatology, Coimbatore Medical College Hospital, Coimbatore. The patients are divided into two groups, group A and group B. The treatment duration was 6 months and the follow up period was 6 months. Each group has 25 patients. Group A patients received topical hand foot PUVA therapy with minimum dose of 1J/cm2 with increment dosage of 0.5J/cm2, in the frequency two times per week and the maximum dose of 24.5J/cm2 in some patients. Eyes were protected by using goggles during treatment. In group B sequential therapy of calcipotriol ointment combinations given in three phases, in phase 1 combination of clobetasol propionate and calcipotriol ointment once a day application in the first month, in phase 2 clobetasol propionate for weekends and calcipotriol for week days once a day application in the second and third month, in phase 3 calcipotriol ointment once a day application in the fourth, fifth and sixth month. PASI score and PASI percentage reduction was assessed at the end of 8th, 16th, 24th weeks. RESULTS: During treatment, 3 patients in group A and 1 patient in group B lost follow up. In both groups none of the patients showed complete clearance of both palms and plantar lesions. In group A out of 22 patients, 20 (90%) showed more than 50% reduction of PASI score. Four patients showed complete clearance of lesion in the palms. Two patients showed complete clearance of lesion in the soles. The average period of clearance of lesions was at 19 weeks. In six months follow up period 3 patients showed relapse after 15 weeks of average period of remission. 4 patients showed adverse effect like erythema and burning sensation. In group B out of 24 patients, all (100%) showed more than 50% reduction of PASI score. Seven patients showed complete clearance of lesion in the palms and five patients showed complete clearance of lesion in the soles. The average period of clearance of lesions was at 20.3 weeks. In six months follow up period 2 patients showed relapse after 20 weeks of average period of remission. 3 patients showed adverse effect like erythema,itching and burning sensation. CONCLUSION: The efficacy of topical calcipotriol ointment and steroid used in sequential manner is better than the topical psoralen ultraviolet A therapy. All the patients (100%) in calcipotriol and steroid combination group showed more than 50% reduction of PASI score. But in PUVA therapy group 90% of patients showed more than 50% reduction of PASI score. On comparing the adverse effects, patients on PUVA therapy group developed more adverse effects than the patients on calcipotriol and steroid combination group. The duration of remission maintenance was long in calcipotriol and steroid combination group when compared to PUVA therapy group. In our study, we arrived at the conclusion that topical therapies used in a sequential manner was more effective and it may be considered as a first line therapy for the treatment of patients with palmoplantar psoriasis.

Palmoplantar Psoriasis and Palmoplantar Pustulosis: Current Treatment and Future Prospects.

Palmoplantar psoriasis and palmoplantar pustulosis are chronic skin diseases with a large impact on patient quality of life. They are frequently refractory to treatment, being generally described as a therapeutic challenge. This article aims to review the definitions of palmoplantar psoriasis and palmoplantar pustulosis, highlighting the similarities and differences in terms of epidemiology, clinical presentation, genetics, histopathology, and pathogenesis, as well as treatment options for both entities. Classical management of mild to moderate palmoplantar pustulosis and palmoplantar psoriasis relies on use of potent topical corticosteroids, phototherapy, and/or acitretin. Nevertheless, these drugs have proven to be insufficient in long-term control of extensive disease. Biologic therapy-namely, anti-interleukin-17 agents and phosphodiesterase type4 inhibitors-has recently shown promising results in the treatment of palmoplantar psoriasis. Knowledge of the pathophysiologic pathways of both entities is of utmost importance and may, in the future, allow development of molecularly targeted therapeutics.

Apremilast, an oral phosphodiesterase-4 inhibitor, in the treatment of palmoplantar psoriasis: Results of a pooled analysis from phase II PSOR-005 and phase III Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis (ESTEEM) clinical trials in patients with moderate to severe psoriasis

Difficult-to-treat palmoplantar psoriasis has a disproportionately negative impact on quality of life. We evaluated the efficacy and safety of apremilast in palmoplantar psoriasis. A post hoc analysis of data pooled from phase IIb (PSOR-005) and phase III (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM] 1 and 2) clinical studies was conducted to determine the effect of apremilast 30mg twice daily versus placebo at week 16 in a subset of patients with moderate to severe plaque psoriasis with active palmoplantar psoriasis (baseline Palmoplantar Psoriasis Physician Global Assessment [PPPGA] score ≥1). Significantly more patients taking apremilast with moderate to severe palmoplantar psoriasis (baseline PPPGA score ≥3) achieved PPPGA score 0 (clear) or 1 (almost clear) compared with placebo at week 16 (48% vs 27%; P=.021). At week 16, 46% of the apremilast group with baseline PPPGA score 1 or higher achieved a PPPGA score of 0 versus 25% of the placebo group (P<.001); 59% of the apremilast group had a PPPGA score of 0 or 1 with 1-point or more improvement versus 39% receiving placebo (P<.001). This post hoc analysis was limited to 16weeks and did not assess palmoplantar pustules, lesion localization, or surface area involvement. Apremilast may be a useful oral treatment option for patients with moderate to severe palmoplantar plaque psoriasis.

Palmoplantar Psoriasis: A Review of Current Therapy

Palmoplantar psoriasis is a variant form of psoriasis that characteristically affects the skin of the palms and soles. It is chronic and inflammatory in nature and presents with hyperkeratotic, pustular, or mixed morphologies. Painful fissuring and bleeding may occur, which produces significant physical, functional, and social disability. Palmoplantar psoriasis is a therapeutically challenging condition and notoriously difficult to treat with topical therapy alone. Furthermore, limited data exist on treatment given that patients are typically excluded from clinical trials, which often require at least 10% body surface area (BSA) involved as an inclusion criterion. This article reviews the topical and systemic agents including biologics that have been investigated in the treatment of palmoplantar psoriasis. Combination therapy, comprising topical, systemic, and/or light treatments, with a particular focus on improvement in function and pain reduction, appears to be the most effective approach in treating these patients.

308-nm Excimer laser treatment of palmoplantar psoriasis

Psoriasis is a chronic inflammatory condition affecting 1–3% of the population. The incidence of palmoplantar involvement has been estimated to be between 2.8% and 40.9%. Significant psychosocial distress and difficulty performing activities of daily living can result. Treatment is often challenging. Traditional treatments include topical steroids, anthralin, calcipotriene, PUVA, methotrexate, cyclosporine, retinoids and biologics. In this case series, we report our success with the 308-nm excimer laser in the treatment of palmoplantar psoriasis.

Treatment of palmoplantar psoriasis with infliximab: a randomized, double‐blind placebo‐controlled study

Palmoplantar psoriasis is a difficult to treat variant of plaque psoriasis. To study the safety and efficacy of infliximab in non-pustular palmoplantar psoriasis. Patients with non-pustular palmoplantar psoriasis affecting at least 10% of their palms and soles and with a modified palmoplantar psoriasis area and severity index (m-PPPASI) of at least eight were recruited. Patients were randomized (1:1) to receive infliximab 5 mg/kg or placebo at weeks 0, 2 and 6. Patients initially randomized to placebo received infliximab at weeks 14, 16 and 20 whereas patients randomized to infliximab received additional infliximab infusions every 8 weeks until week 22. Twenty four (24) patients were randomized in this study. At week 14, 33.3% and 66.7% of patients treated with infliximab achieved m-PPPASI 75 and m-PPPASI 50 respectively compared to 8.3% for both m-PPPASI 75 (P = 0.317) and m-PPPASI 50 (P = 0.009) for patients randomized to placebo. A reduction of 50.3% in the mean surface area of palms and soles affected with psoriasis was seen at week 14 in patients randomized to infliximab as compared to an increase of 14.9% in patients randomized to placebo (P = 0.009). This pilot study did not reach its primary endpoint of m-PPPASI 75 at week 14. However, infliximab was observed to be more efficacious than placebo in improving PPSA and with respect to the percentage of patients reaching m-PPPASI 50 at week 14. Larger and longer term studies are needed for severe patients to better assess the efficacy of infliximab in palmoplantar psoriasis.

Comparative therapeutic evaluation of different topicals and narrow band ultraviolet B therapy combined with systemic methotrexate in the treatment of palmoplantar psoriasis

Background:The incidence of uncomplicated psoriasis is 1–3% in the general population. The involvement of palm and sole is seen in 7–14.5% of cases. There are different topicals and systemic therapies available for treating the case of psoriasis but none is satisfactory for longer duration.Aim:The study involved the comparative therapeutic evaluation of the different topical regimens and narrow band ultraviolet B (NB-UVB) therapy in combination with systemic methotrexate.Materials and Methods:The study was held in out-patient department of Skin, VD and Leprosy of B.R.D. Medical College, Gorakhpur, from July 2007 to December 2008. The group included 98 new cases of palmoplantar psoriasis. These cases were divided into eight groups according to the eight regimens involved in the study. The severity of psoriasis was assessed by the ESIF (erythema, scaling, induration and fissuring) score.Results:The study showed that all the regimens had significant response rates. The combination of NB-UVB with systemic methotrexate had maximum response rate (64.85±4.52%) that was statistically significant (paired “t” at 16d.f. = 33.329, P<0.001) with minimum number of recurrences after stopping the treatment. The combination of halobetasol ointment with systemic methotrexate also had significant response rate (paired “t” at 19d.f. = 13.5183, P<0.001) but had maximum number of cases with recurrence (70%) after stopping the treatment.Conclusion:These results suggest that the combination of every regimen with systemic methotrexate resulted in an early and a good improvement in the quality of life of patients suffering from psoriasis. It also shows that NB-UVB in combination with systemic methotrexate is more efficacious and has minimum recurrence rate and side effects in the treatment of palmoplantar psoriasis.