Palmoplantar Pustulosis: A Systematic Review of Risk Factors and Therapies

Abstract

Palmoplantar pustulosis (PPP) is a chronic, relapsing, inflammatory disease that can occur alone or in association with arthritis. There is still controversy about whether it should be separated from psoriasis or classified as pustular psoriasis. Furthermore, drug-induced paradoxical PPP is a special variant of PPP that differs from classic PPP in several ways. Treatment of PPP is still challenging, and there are a number of treatment-resistant cases. This review summarizes the risk factors for the development of PPP and the currently available treatment modalities. Female sex, smokers or ex-smokers, obesity, thyroid dysfunction, and treatment with a tumor necrosis factor (TNF)-α inhibitor have been identified as risk factors for the disease’s development, severity, and course. Topical treatments and phototherapy are effective for some patients and are used as a first-line or adjuvant treatment modality. Conventional treatments including retinoids and fumaric acid show good effects and can increase the efficacy of treatment with psoralen + ultraviolet light therapy (PUVA). Ciclosporin is fast acting, but relapse mostly occurs immediately after cessation. TNF-α inhibitors are efficient, and an even better response can be achieved with IL-17 and IL-23 blockers as well as apremilast. The effect of Janus kinase inhibitors seems to be promising according to case reports, but further investigations with larger cohorts are needed.

Combination of secukinumab and acitretin for generalized pustular psoriasis: A case report and review of literature

“…9 Some manifestations are presented with palmoplantar pustulosis and GPP. 9,10 Currently, there is no standard treatment for GPP. Therefore, first-line treatment for the condition consists of established therapies, such as acitretin, cyclosporine, methotrexate and infliximab.…”

Skin Symptoms That Appeared after Fixation with a Titanium Plate in a Jaw Deformity Patient Suffering from Palmoplantar Pustulosis: A Case Report

“…Palmoplantar pustulosis (PPP) is a chronic inflammatory disease characterized by erythematous keratotic lesions with cracking, bleeding, and pain. Clinical manifestations include small, sterile pustules on the palms and soles [1,2]. The prevalence of PPP ranges from 0.050 to 0.12%, and PPP is more common in women, with the highest prevalence in those aged 50-69 years [3].…”