Itraconazole as a New Treatment for Pustulosis Palmaris et Plantaris

Mihara, Motoyuki; Hagari, Yoshitaka; Morimura, Tsukasa; Nakayama, Hidetoshi; Ishihara, Masahiko; Aki, Toshiyuki; Inoue, Taeko

doi:10.1001/archderm.134.5.639

Cited by 12 publications

(11 citation statements)

References 4 publications

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“…Here the authors report significant reduction in the frequency of pustular eruptions, the number of pustules, and the severity of erythema and desquamation with tolerable doses (100 mg/day) of oral itraconazole for 2 months. The findings were in line with prior experience by others (16). Despite the fact that this was not a placebo-controlled study, the authors think that the fact that three of the six patients reached complete response is highly indicative of the activity of itraconazole in PPP as complete responses have not been observed in a recent review of 23 placebo-controlled trials for PPP treatments (25).…”

Section: Resultssupporting

confidence: 89%

“…In particular, itraconazole inhibits chemotaxis of neutrophils, the production of IL‐8 and synthesis of pro‐inflammatory metabolites (i.e., 5‐lipoxygenase) (14,15). Furthermore, itraconazole has shown anecdotal activity for the treatment of PPP (16). Given the involvement of inflammatory mediators in PPP, the anti‐inflammatory activity of itraconazole, and one prior report of activity in PPP, the authors set out to test the efficacy of itraconazole in six patients with therapy‐resistant PPP.…”

Section: Discussionmentioning

confidence: 99%

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Palmoplantar pustulosis treated with itraconazole: a single, active-arm pilot study

V'lckova-Laskoska

Caca‐Biljanovska

Laskoski

et al. 2009

Dermatologic Therapy

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Pustulosis palmoplantaris (PPP; synonyms: pustulosis palmaris et plantaris, palmoplantar amicrobic pustulosis) is a common chronic, relapsing, pustular eruption affecting the palms and soles. The authors report the successful treatment of six therapy-experienced patients with histologically confirmed PPP with oral itraconazole (100 mg/day for 1 month, followed by a month of 100 mg/day every other day). Three of six patients showed complete clearance of pustules, significant reduction of erythema, and unnoticeable desquamation, whereas the other three patients had no new pustules appearing and had modest reduction of erythema and desquamation. All patients experienced relapses within a month of therapy cessation. Two of the three complete responders reinitiated itraconazole therapy at 100 mg/day for another 2 weeks, followed by a maintenance dose of 50 mg/day until achieving remission. As complete responses are not commonly observed in placebo treatments in placebo-controlled trials for PPP, the authors believe that the present study shows that itraconazole is an effective treatment for treatment-resistant PPP.

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Section: Resultssupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Palmoplantar pustulosis treated with itraconazole: a single, active-arm pilot study

V'lckova-Laskoska

Caca‐Biljanovska

Laskoski

et al. 2009

Dermatologic Therapy

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“…In North America and Switzerland, where alefacept is registered, there is limited evidence for a favourable response at least in a subgroup of patients 40,41 . Two observations provide evidence that the antifungal drug itraconazole may be useful to treat PPP 42,43 …”

Section: Drug Treatment Of Palmoplantar Pustulosismentioning

confidence: 99%

“…40,41 Two observations provide evidence that the antifungal drug itraconazole may be useful to treat PPP. 42,43 In an interesting contrast to psoriasis, TNF-a antagonists are of very limited value for PPP therapy. In some case reports, an improvement was reported whereas in others there was no effect on PPP.…”

Section: Drug Treatment Of Palmoplantar Pustulosismentioning

confidence: 99%

Management of palmoplantar pustulosis: do we need to change?

Mrowietz

Kerkhof

2011

British Journal of Dermatology

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Palmoplantar pustulosis (PPP) is difficult to treat. There is little hard evidence for the efficacy of any treatment and no published guidelines for its management. A number of exacerbating factors are well documented and there is some evidence for the importance of others. Smoking is the most recognized environmental trigger and recent research has concentrated on the role of eccrine sweat glands in this regard. Other factors, including tonsillar streptococcal infection and gluten sensitivity, may be important in selected cases. The aim of this review is to challenge dermatologists to consider alternative management strategies for PPP and design clinical trials that will enable the development of useful therapeutic guidelines.

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“…Itraconazole (ICZ) is an antifungal triazole compound that inhibits cytochrome P450, which catalyzes the synthesis of ergosterol, an essential component of the cell membrane, thereby inhibiting fungal growth (Zuckerman and Tunkel, 1994;Haria et al, 1996). In addition to antifungal activity, ICZ has been reported to possess an antiinflammatory potential and has also shown therapeutic benefits for antimicrobial palmoplantar pustulosis (Mihara et al, 1998), seborrhoeic dermatitis (Hay and Graham-Brown, 1997), and atopic dermatitis (Kolmer et al, 1996;Ikezawa et al, 2004). However, it remains unknown whether ICZ has an anti-inflammatory potential in regard to chemokine production by oral fibroblasts.…”

Section: Introductionmentioning

confidence: 99%