Resistant Palmoplantar Lesions in Patients of Psoriasis: Evaluation of the Causes and Comparison of the Frequency of Delayed-Type Hypersensitivity in Patients without Palm and Sole Lesions

Al-Mutairi, Nawaf; Abdalla, Tarek O.; Nour, Tarek

doi:10.1159/000365573

Cited by 14 publications

(15 citation statements)

References 24 publications

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“…ACD reactions in palmoplantar localisation are often chronic and due to the ubiquitous character of allergens not self-limited. Persistent ACD acts as a negative determinant of psoriasis (5). Allergy diagnostic including patch testing is essential for the correct diagnosis, successful treatment and, in our opinion, mandatory in cases of palmoplantar psoriasis.…”

Section: Discussionmentioning

confidence: 95%

“…However, there are conflicting results regarding the correlation of psoriasis and contact sensitivity. Some authors have observed an inverse relationship (4), while others have reported a higher incidence of type IV sensitization only in palmoplantar psoriasis (5,6). Another study noted a positive correlation with the duration of the disease, but not with the site of lesions (7).…”

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confidence: 99%

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Eczema in Psoriatico: An Important Differential Diagnosis Between Chronic Allergic Contact Dermatitis and Psoriasis in Palmoplantar Localization

Kolesnik

Franke²,

Lux³

et al. 2018

Acta Derm Venerol

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Differential diagnosis of palmoplantar non-pustular psoriasis and chronic allergic contact dermatitis (ACD) and the combination of these conditions, termed "eczema in psoriatico" (EIP), is difficult, especially in cases of isolated involvement. A blind re-evaluation of 63 archived formalin-fixed palmoplantar samples, previously diagnosed clinically as either psoriasis or chronic ACD, was performed. Samples were allocated to histopathological diagnoses of psoriasis, contact dermatitis or EIP. Immunohistological stainings were performed for better characterization. Immunochemistry of EIP revealed features that overlapped contemporarily with psoriasis (cytokeratin 17 (CK17), Ki67, interleukin (IL)-8, IL-17, IL-23) and with ACD (CD1a, major histocompatibility complex (MHC) class I, MHC class II, epidermal T-cell subsets). Surprisingly, a significantly much higher number of dermal CD8+ T cells was found in EIP than in ACD and psoriasis. In conclusion, this study provides insight into the immunohistological differentiation of palmoplantar psoriasis, chronic ACD and EIP.

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Eczema in Psoriatico: An Important Differential Diagnosis Between Chronic Allergic Contact Dermatitis and Psoriasis in Palmoplantar Localization

Kolesnik

Franke²,

Lux³

et al. 2018

Acta Derm Venerol

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“…Palmoplantar psoriasis is more challenging to treat than psoriasis in other skin areas. The use of topical therapies, ultraviolet phototherapy, oral retinoids, methotrexate or anthralin often results in inadequate treatment results . Newer small molecules and biologics have increased the possibility of effective treatment, but the evidence for this is limited and often from short‐term studies .…”

mentioning

confidence: 99%

Sustained efficacy of secukinumab in patients with moderate‐to‐severe palmoplantar psoriasis: 2·5‐year results from GESTURE , a randomized, double‐blind, placebo‐controlled trial

Gottlieb

Kubanov²,

Doorn

et al. 2019

Br J Dermatol

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Summary Background Secukinumab has shown sustained efficacy and safety in several manifestations of psoriasis. Objectives GESTURE investigated the long‐term (2·5‐year) safety and efficacy of 150 mg and 300 mg subcutaneous secukinumab in 205 patients with moderate‐to‐severe palmoplantar psoriasis. Methods GESTURE was a randomized, double‐blind, placebo‐controlled, multicentre, phase IIIb trial conducted across 15 countries. The study was 140 weeks long and consisted of four periods: screening (up to 4 weeks), treatment period 1 (16 weeks), treatment period 2 (116 weeks) and post‐treatment follow‐up (8 weeks). Eligible patients were aged ≥ 18 years with moderate‐to‐severe palmoplantar psoriasis and at least one plaque outside of the palms and soles. Efficacy was assessed via a palmoplantar Investigator's Global Assessment (ppIGA) and the palmoplantar Psoriasis Area and Severity Index (PASI). Results The primary end point, a ppIGA score of 0 or 1, was met at week 16. The effect was sustained over 2·5 years with 59% [95% confidence interval (CI) 43·5–74·1] and 53% (95% CI 35·1–69·6) of patients in the secukinumab 300 mg and 150 mg groups, respectively, achieving clear or almost clear palms and soles (ppIGA 0 or 1). At 2·5 years, the mean palmoplantar PASI percentage was reduced in both the secukinumab 300 mg group (−74·7%) and the secukinumab 150 mg group (−61·6%). A total of 17% (secukinumab 300 mg group) and 18% (secukinumab 150 mg group) of patients experienced no difficulty in hands and feet functionality, as indicated by the palmoplantar quality of life instrument overall scores. The safety profile was favourable. Conclusions GESTURE revealed that secukinumab provides a strong and sustained response over 2·5 years in challenging‐to‐treat palmoplantar psoriasis.

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“…81 Also, the use of several topics in resistant lesions can make the patient susceptible to contact hypersensitivity. 82 Therefore, topic treatments should be the preferred approach in a patient with PPP. However, many patients end up, eventually requiring treatment with systemic drugs, which present risks of side effects that may restrict their use in clinical practice.…”

Section: Treatmentmentioning

confidence: 99%

<p>Diagnosis, Screening and Treatment of Patients with Palmoplantar Pustulosis (PPP): A Review of Current Practices and Recommendations</p>

Freitas¹,

Rodrigues²,

Torres³

2020

CCID

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Palmoplantar pustulosis (PPP) is a rare, chronic, recurrent inflammatory disease that affects the palms and/or the soles with sterile, erupting pustules, which are debilitating and usually resistant to treatment. It has genetic, histopathologic and clinical features that are not present in psoriasis; thus, it can be classified as a variant of psoriasis or as a separate entity. Smoking and upper respiratory infections have been suggested as main triggers of PPP. PPP is a challenging disease to manage, and the treatment approach involves both topical and systemic therapies, as well as phototherapy and targeted molecules. No gold standard therapy has yet been identified, and none of the treatments are curative. In patients with mild disease, control may be achieved with on-demand occlusion of topical agents. In patients with moderate-to-severe PPP, phototherapy or a classical systemic agent (acitretin being the best treatment option, especially in combination with PUVA) may be effective. Refractory patients or those with contraindications to use these therapies may be good candidates for apremilast or biologic therapy, particularly anti-IL-17A and anti-IL-23 agents. Recent PPP trials are focusing on blockage of IL-36 or IL-1 pathways, which play an important role in innate immunity. Indeed, IL-36 isoforms have been strongly implicated in the pathogenesis of psoriasis. Therefore, blockage of the IL-36 pathway has become a new treatment target in PPP, and three studies are currently evaluating the use of monoclonal antibodies that block the IL-36 receptor in PPP: ANB019 and spesolimab (BI 655130). In this review, we explore the diagnosis, screening and treatment of patients with PPP.

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Resistant Palmoplantar Lesions in Patients of Psoriasis: Evaluation of the Causes and Comparison of the Frequency of Delayed-Type Hypersensitivity in Patients without Palm and Sole Lesions

Cited by 14 publications

References 24 publications

Eczema in Psoriatico: An Important Differential Diagnosis Between Chronic Allergic Contact Dermatitis and Psoriasis in Palmoplantar Localization

Eczema in Psoriatico: An Important Differential Diagnosis Between Chronic Allergic Contact Dermatitis and Psoriasis in Palmoplantar Localization

Sustained efficacy of secukinumab in patients with moderate‐to‐severe palmoplantar psoriasis: 2·5‐year results from GESTURE , a randomized, double‐blind, placebo‐controlled trial

<p>Diagnosis, Screening and Treatment of Patients with Palmoplantar Pustulosis (PPP): A Review of Current Practices and Recommendations</p>

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