PUVA therapy for palmoplantar pustulosis

Forty patients suffering from pustulosis palmoplantaris were treated with PUVA therapy. Thirty-six patients had palmar lesions which cleared in 31 cases; in 18 cases after an initial course of 3 sessions of treatment per week during an average period of 10 weeks, and in another 13 only after additional, less frequent continuation of the PUVA therapy. The average total UVA dose at clearing of the palmar lesions was 191 and the final UVA dose 7.3 J/cm2. After 2 years, 9 out of the 31 cases of palmar lesions were still completely healed, and the average duration of remission was greater than or equal to 15 months. For plantar lesions the results of PUVA therapy, using essentially the same procedure, were less satisfactory: healing being obtained in only 5 out of 34 cases. However, for palmar and plantar lesions alike, most patients have reported long-standing improvement from PUVA therapy. A surprisingly high frequency of nausea was noted as a side-effect.     

Therapeutic options for palmoplantar pustulosis

Palmoplantar pustulosis (PPP) is a common chronic and recurrent pustular dermatosis characterized by multiple sterile pustules and erythematous plaques on the palms and soles. The exact cause and pathogenesis of the disease remain unknown, and there is still debate about whether PPP is a variant of psoriasis or a distinct condition. A review of the medical literature revealed that a wide range of treatments have been used in the treatment of PPP over the years. The literature in PPP is restricted to case reports or small case series, and there is a lack of well‐documented clinical studies, which makes it difficult to select an ideal therapy for the condition. The purpose of this review is to discuss the current therapy options for PPP, based on results of randomized controlled trials.     

Acute palmoplantar pustulosis

This paper describes five cases of an uncommon acral rash, acute palmoplantar pustulosis, which is precipitated by infection, and may represent a true pustular bacteria. Acute and chronic palmoplantar pustulosis are probably different forms of the same disease, but the prognosis in the acute form is good and aggressive therapy is not indicated. The relationship to psoriasis is discussed.     

Arthro-osteitis with palmoplantar pustulosis

An elderly woman with chronic palmoplantar pustulosis who developed sclerosing osteitis of both clavicles is described.     

Alitretinoin abrogates innate inflammation in palmoplantar pustular psoriasis

Background Palmoplantar pustular psoriasis is often recalcitrant to therapy. Here we evaluated the therapeutic effect of alitretinoin in patients with recalcitrant palmoplantar pustular psoriasis and investigated subsequent immunopathological alterations. Methods Seven patients with palmoplantar pustular psoriasis were treated with oral alitretinoin 30 mg once daily for 12 weeks. Efficacy was assessed by palmoplantar pustular psoriasis area and severity index (PPPASI), visual analogue scales (VAS) on intensity of pain and pruritus and an overall patient assessment. Immunohistochemical staining for neutrophil elastase, CD3, CD4, CD8, CD1a CD11c, CD303,CD68, CD69, CD208 and HLA‐DR was on lesional skin biopsies obtained before and after 12 weeks of treatment. Results PPPASI and VAS for pruritus and pain decreased significantly after 12 weeks of treatment with alitretinoin. The overall patient assessment ranged from 60% to 90% clinical improvement. In correlation with clinical improvement a significant reduction, particularly of neutrophils, macrophages and dendritic cells, was also observed in the skin sections. Alitretinoin was well tolerated except for headache during the first month of treatment in two patients. Limitations of the study are a missing control group and the concomitant usage of topical therapy. Discussion Our findings suggest that alitretinoin may represent a new and promising therapy for recalcitrant palmo‐plantar psoriasis and warrants further controlled studies to confirm efficacy and safety of alitretinoin in this disease.     

掌跖脓疱病发病的相关因素研究进展

掌跖脓疱病是一种病因不明,发生于掌跖部位的慢性、炎症性、复发性疾病,该病以在红斑的基础上周期性发生簇集性无菌性小脓疱,伴角化、脱屑为临床特征,好发年龄在30 ～ 50岁,女性比男性多见.近年来,随着掌跖脓疱病发病率的增加,带动了一系列关于其病因的研究和临床试验.分别就掌跖脓疱病与免疫、吸烟因素、金属致敏、血浆钙离子水平以及感染等诸方面的关系进行概述,旨在为掌跖脓疱病患者的诊疗带来一定的帮助.     

Extra-palmoplantar lesions associated with palmoplantar pustulosis

Palmoplantar pustulosis (PPP) is a chronic inflammatory disorder characterized by sterile pustules predominantly involving the palms and soles of middle-aged women. In contrast, regions other than the palms and soles are occasionally affected, manifesting scaly erythemas which resemble psoriasis, and solitary pustules are also seen. Some of these extra-palmoplantar lesions are induced by the Koebner phenomenon or occur after focal infections like tonsillitis. The tenderness and inflammation of the extra-palmoplantar lesions in PPP are milder than in psoriasis. Histological features show mild acanthosis of the epidermis with parakeratosis and mild infiltration of inflammatory cells in the upper dermis. On the other hand, severe pustular lesions are occasionally seen in the palms and soles of the patients with pustular psoriasis. These findings suggest a close relationship between PPP and psoriasis; however, different genetic, environmental, and immunological factors are likely to be involved. Recently, understanding of psoriasis pathophysiology has greatly progressed, and the concept of psoriasis pathogenesis is currently viewed as complicated responses between infiltrating leucocytes and the resident skin, via a number of inflammatory cytokines, chemokines, and mediators produced in the skin under regulation of cellular immune systems. By contrast, the pathogenesis of PPP has been poorly investigated. This paper reviews findings of the clinicopathophysiology of PPP, making a focus on the extra-palmoplantar lesions.     

A controlled trial of photochemotherapy for persistent palmoplantar pustulosis

Twenty-two patients with bilaterally symmetrical persistent palmoplantar pustulosis were treated on one randomly selected side with oral psoralen and long-wave ultraviolet light. The treated side cleared completely in twelve patients, almost cleared in five patients and improved in four. One patient improved on both sides. Fifteen of the twenty-two patients were then treated with topical psoralen and long-wave ultraviolet light on the side that had previously been used as a control. Similar results were obtained. Seven patients cleared completely, six patients were much improved and two were improved. These results are significantly different from those liable to occur by chance (P > 0.001).     

Inefficacy of topical methoxalen plus UVA for palmoplantar pustulosis

The effect of local application of 8-methoxypsoralen (8-MOP) and subsequent UVA irradiation on palmoplantar pustulosis (PPP) was studied in 10 patients. In 8 patients 8-MOP baths were used, and in 5 patients an 8-MOP ointment was applied, 3 patients receiving both forms of treatment. The number of treatment sessions varied from 15 to 128, with maximal UVA doses of 1.2 to 12 J/cm2, and total cumulative doses of 8 to 348 J/cm2. Two patients experienced a brisk phototoxic erythema and one patient developed a bullous reaction. Only 3 patients responded favourably to the treatment, 2 with moderate and 1 with good clearing of the lesions. In the remaining 7 patients either no effect (5 patients) or an exacerbation of the disease (2 patients) was seen.