Biologic therapies associated with development of palmoplantar pustulosis and palmoplantar pustular psoriasis: a systematic review

Abstract

Background Palmoplantar pustulosis (PPP) and palmoplantar pustular psoriasis (PPPP) are chronic inflammatory skin conditions characterized by eruptions of sterile pustules on the palms and/or soles. Biologic use has been associated with PPP and PPPP development in the literature.Objectives To identify PPP and PPPP associated with biologics and summarize reported treatments and outcomes.Methods We systematically searched in MEDLINE and Embase for articles that reported PPP or PPPP during biologic treatment. After a full-text review, 53 studies were included for analysis. ResultsWe identified 155 patients with PPP/PPPP onset during biologic treatment, with a mean age of 44.1 years and a female preponderance (71.6%). The most frequently reported biologics were adalimumab (43.9%) and infliximab (33.3%). IL-17 inhibitors, secukinumab (7.6%) and brodalumab (1.5%), were reported only in association with PPPP.Overall, 58.8% of patients had complete remission (CR) in 3.6 months and 23.5% had partial remission (PR) in 3.7 months. The most common treatments that led to CR were topical corticosteroids (n = 16) and biologic switching (n = 8).Conclusions Clinicians should anticipate PPP or PPPP as potential drug reactions to biologics such as adalimumab and infliximab. Large-scale studies are required to confirm our findings and further explore the pathogenesis for biologic-associated PPP and PPPP.

Adalimumab-induced palmoplantar pustulosis in a patient with inflammatory bowel disease

“…In a systematic review by Lu et al, the mean latency period before the onset of pustular lesions after adalimumab administration was 7.8 months (range: 0.3-36.5 months). [3] In our patient, the latency period was 27 months. Topical corticosteroids are used to control palmoplantar pustulosis.…”

“…The mean time to attain complete resolution was found to be 4.2 months (range: 0.5-11 months). [3] Among patients treated with topical corticosteroids, 60% achieved complete remission in 3.5 months. [3] Paradoxical reactions following biologic therapy are uncommon.…”

“…[3] Among patients treated with topical corticosteroids, 60% achieved complete remission in 3.5 months. [3] Paradoxical reactions following biologic therapy are uncommon. They induce psoriasis-like lesions in 2-5% of patients.…”

Palmoplantar Pustulosis: A Systematic Review of Risk Factors and Therapies

“…Under treatment with TNF-α inhibitors, paradoxical psoriasiform lesions occur in 1.56% of treated patients or 2–5% according to a recently published review about biological-induced PPP. 109 Although non-pustular variants are the most frequent paradoxical reaction, the relative risk of development of PPP is the highest. 22 In cohorts of patients treated with TNF-α inhibitors, PPP appeared in 0.12–0.66% of patients with a mean onset after 6 months of treatment.…”

“… 109 Others have hypothesized that an overexpression of CXCR3 occurs with recruitment of auto-reactive T cells and increased release of INF-α. 109 Adalimumab and infliximab followed by etanercept are the most frequently reported causative TNF-α inhibitors. 19 However, there are also reports about certolizumab and other biologics, including secukinumab, brodalumab, ustekinumab, rituximab, atezolizumab, and tocilizumab, as well as the JAK inhibitors tofacitinib and baricitinib.…”