Palmoplantar Psoriasis and Palmoplantar Pustulosis: Current Treatment and Future Prospects

Abstract

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 type 4 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.

Efficacy of ixekizumab compared to etanercept and placebo in patients with moderate‐to‐severe plaque psoriasis and non‐pustular palmoplantar involvement: results from three phase 3 trials (UNCOVER‐1, UNCOVER‐2 and UNCOVER‐3)

“…Patients with pustular psoriasis, a difficult-to-treat variant of psoriasis, 16,21 were excluded from the phase 3 trials. 5,22,23 Gottlieb et al have reported the efficacy of another IL-17A antagonist, secukinumab, in patients with non-pustular palmoplantar psoriasis. Although patients treated with ixekizumab did have improvements in health-related quality of life, specific quality of life outcomes for palmoplantar psoriasis such as the PalmarPlantar Quality-of-Life Index described by Farley and colleagues 4 were not assessed in the UNCOVER trials.…”

“…[1][2][3] These patients may have localized palmoplantar psoriasis [3][4][5] or generalized psoriasis in addition to the palms and soles. [1][2][3] These patients may have localized palmoplantar psoriasis [3][4][5] or generalized psoriasis in addition to the palms and soles.…”

“…Palmoplantar psoriasis is characterized by well-demarcated hyperkeratotic plaques that may or may not be associated with pustules. [4][5][6][7][8][9] Palmoplantar psoriasis is associated with greater physical disability than psoriasis without palm and sole involvement as well as overall greater disease severity, 10,11 more impairment of health-related quality of life and greater problems with mobility, self-care and usual activities, 4,11 higher levels of burning, skin soreness 10 and pain. 6 The relationship between palmoplantar types and subtypes is an area of significant interest and research especially relating to genetic similarities and differences and therapeutic options.…”

Psoríase pustulosa palmoplantar na infância: um relato de caso

“…O diagnóstico diferencial de pustulose palmoplantar inclui infecção fúngica superficial, erupção bacteriana, disidrose 10 , acrodermatite contínua de Hallopeau, psoríase anular e dermatite de contato irritante 1,2,11,7 . A doença geralmente cursa com resistência ao tratamento e remissões frequentes 7 , sendo essas observadas na maioria dos pacientes por curtos períodos, de no máximo um ano, no qual as lesões geralmente coalescem e se resolvem, resultando em uma descoloração amarronzada 6 .…”

“…A região palmoplantar por apresentar o estrato córneo mais espesso, representa uma barreira para ação adequada de agentes no tratamento tópico, fato que explica a eficácia moderada destas formas de tratamento. Tratamentos sistêmicos para a PPP têm mostrado eficácia limitada quando comparados a outras lesões psoriasiformes 11 . Em adultos, o tratamento inclui fototerapia, fotoquimioterapia e agentes sistêmicos como retinóides, metotrexato, ciclosporina e agentes biológicos, como alefacept, infliximab, adalimumab e efalizumab 5,10,14 .…”