Refractory Palmoplantar Pustulosis Successfully Treated with JAK Inhibitor Tofacitinib: A Case Series

Abstract

Background: Palmoplantar pustulosis (PPP) is a common chronic and recurrent skin disease of the palms and soles with significant pain, mental distress, and functional disability. PPP is challenging to treat and usually requires prolonged management. Therapy resistance and frequent relapse discourages patients from follow-up. No unified standard and no published therapeutic guidelines have yet been defined on PPP treatment. In general, all therapeutic options known for autoimmune diseases, psoriasis in particular, have been tested in PPP. Tofacitinib, an oral JAK inhibitor, has been approved for the treatment of rheumatoid arthritis and shows promise in the treatment of moderate-to-severe plaque psoriasis. However, no clinical trials or case reports have been conducted to confirm the efficacy of tofacitinib in palmoplantar pustulosis. Methods: Six in total with 6 PPP patient, aged 42-58 years were recruited according to the inclusion and exclusion criteria. Patient characteristics, including triggering factors, concomitant diseases, and previous therapeutic drugs, were investigated. All patients experienced a lack of response to topical drugs and at least one systemic agent. During treatment, visits were scheduled at the start of treatment and at 2, 4, and 12 weeks, and efficacy was assessed using the PPP ASI and PPP PGA. Results: Our six patients showed an excellent response to tofacitinib as all patients did achieve at least 50% reduction and half of our patients with more than 80% reduction in PPPASI after 4 weeks treatment; at week 12, 5 (83.3%) patients had 80% reduction in PPPASI with no serious adverse events were reported. Conclusion:The JAK inhibitor tofacitinib is a promising treatment for refractory palmoplantar pustulosis that requires further clinical observation and research.

Associations of inflammatory cytokines with palmoplantar pustulosis: a bidirectional Mendelian randomization study

“…Furthermore, tofacitinib, a JAK inhibitor, has been shown in multiple studies to alleviate refractory PPP. This treatment rapidly reduces the severity of skin lesions, such as erythema, aseptic pustules, and desquamation (85,86). The findings of this research strongly endorse the future target of JAK/STAT3 signaling in PPP and offer genetic evidence for the use of tofacitinib in the treatment of refractory PPP.…”

A novel approach with tofacitinib for the management of keratoderma blennorrhagicum in reactive arthritis: a case report

“…A 45-year-old woman with plaque psoriasis and painful pustules on her palms and soles showed significant improvement in joint symptoms and lesion clearance after three months of tofacitinib ( 15 ). Another study involving six patients aged 42–58 with PPP demonstrated substantial improvement with tofacitinib, with all patients achieving at least a 50% reduction in palmoplantar pustular psoriasis area and severity index (PPPASI) after four weeks, and half experiencing more than an 80% reduction ( 16 ).…”