Ustekinumab in Refractory Palmoplantar Pustular Psoriasis
Ustekinumab in Refractory Palmoplantar Pustular Psoriasis
Background Palmoplantar pustulosis (PPP) is characterized by sterile pustules with hyperkeratosis, erythema, scaling and fissuring on the palms and soles. PPP can present alone, or in association with palmoplantar pustular psoriasis (PPPP).
Objectives To examine treatment with ustekinumab in patients with severe refractory PPPP.
Methods Five patients (two men and three women, age 30–50 years) with severe refractory PPPP were treated with ustekinumab, according to a pre-established protocol. A 45 mg dose of ustekinumab was administered subcutaneously, followed by a 45 mg dose 4 weeks later and every 12 weeks thereafter. The severity of involvement and the therapeutic outcome were evaluated in every patient before, during and after treatment.
Results Positive responses to ustekinumab were initially seen in all of the patients 2–3 weeks after the first dose, and were more remarkable after the second injection. Complete resolution of PPPP was achieved at week 20 and was maintained in all patients.
Conclusions Ustekinumab appears to be an effective and safe therapeutic option in PPPP, leading to complete or nearly complete resolution of lesions and a significant improvement in patients' quality of life.
Palmoplantar pustulosis (PPP) is characterized by sterile pustules with hyperkeratosis, erythema, scaling and fissuring on the palms and soles. It has been reported to be more frequent in middle-aged women, smokers and patients with diabetes, and it is increasingly being reported as a paradoxical reaction to antitumour necrosis factor (anti-TNF)-α biological agents. PPP can present alone, or in association with psoriasis vulgaris [palmoplantar pustular psoriasis (PPPP)]. The nosological distinction between both entities is still subject to discussion, but they are both refractory to many therapeutic options, including topical treatments (corticosteroids, vitamin D derivatives and coal-tar solutions) and systemic therapies (photochemotherapy, ciclosporin, methotrexate and acitretin). Biological agents are highly effective in moderate-to-severe psoriasis vulgaris, and their efficacy in nonpustular palmoplantar psoriasis has been shown in a clinical trial, but only sporadic cases and very few reports have been published in support of their possible therapeutic efficacy in PPP and PPPP.
We present our experience with ustekinumab in five patients with severe refractory PPPP.
Abstract and Introduction
Abstract
Background Palmoplantar pustulosis (PPP) is characterized by sterile pustules with hyperkeratosis, erythema, scaling and fissuring on the palms and soles. PPP can present alone, or in association with palmoplantar pustular psoriasis (PPPP).
Objectives To examine treatment with ustekinumab in patients with severe refractory PPPP.
Methods Five patients (two men and three women, age 30–50 years) with severe refractory PPPP were treated with ustekinumab, according to a pre-established protocol. A 45 mg dose of ustekinumab was administered subcutaneously, followed by a 45 mg dose 4 weeks later and every 12 weeks thereafter. The severity of involvement and the therapeutic outcome were evaluated in every patient before, during and after treatment.
Results Positive responses to ustekinumab were initially seen in all of the patients 2–3 weeks after the first dose, and were more remarkable after the second injection. Complete resolution of PPPP was achieved at week 20 and was maintained in all patients.
Conclusions Ustekinumab appears to be an effective and safe therapeutic option in PPPP, leading to complete or nearly complete resolution of lesions and a significant improvement in patients' quality of life.
Introduction
Palmoplantar pustulosis (PPP) is characterized by sterile pustules with hyperkeratosis, erythema, scaling and fissuring on the palms and soles. It has been reported to be more frequent in middle-aged women, smokers and patients with diabetes, and it is increasingly being reported as a paradoxical reaction to antitumour necrosis factor (anti-TNF)-α biological agents. PPP can present alone, or in association with psoriasis vulgaris [palmoplantar pustular psoriasis (PPPP)]. The nosological distinction between both entities is still subject to discussion, but they are both refractory to many therapeutic options, including topical treatments (corticosteroids, vitamin D derivatives and coal-tar solutions) and systemic therapies (photochemotherapy, ciclosporin, methotrexate and acitretin). Biological agents are highly effective in moderate-to-severe psoriasis vulgaris, and their efficacy in nonpustular palmoplantar psoriasis has been shown in a clinical trial, but only sporadic cases and very few reports have been published in support of their possible therapeutic efficacy in PPP and PPPP.
We present our experience with ustekinumab in five patients with severe refractory PPPP.