Showing papers on "Palmoplantar pustulosis published in 2020"
TL;DR: The current understanding of PPP is summarized, including the revised definition and possible pathomechanism, which provides a more complete picture of the disease and may facilitate the development of improved treatment options.
53 citations
TL;DR: Various treatments, including nonsteroidal anti-inflammatory drugs, conventional disease-modifying antirheumatic drugs, bisphosphonates, biologics, and antibiotics, are promising options for alleviating the disease.
Abstract: Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a spectrum of heterogeneous diseases characterized by osteoarticular and dermatological manifestations. Osteitis and hyperostosis are core clinical manifestations in SAPHO syndrome, typically affecting multiple areas and possibly progressing to irreversible osteoarticular damage. Most patients with SAPHO have cutaneous involvement, mainly manifested as palmoplantar pustulosis and severe acne. Systemic manifestations are uncommon but occasionally reported. Epidemiological studies suggest the annual prevalence of SAPHO syndrome varies from 0.00144 in 100,000 in Japanese individuals to fewer than 1 in 10,000 in White individuals. The precise etiopathogenesis of SAPHO remains unclear, but it is generally considered an autoinflammatory syndrome that may be related to various etiologies, such as immune dysfunction, infection and genetic predisposition. Owing to the relapsing-remitting disease course, the goal of management is to improve clinical symptoms and prevent disease progression. Various treatments, including nonsteroidal anti-inflammatory drugs, conventional disease-modifying antirheumatic drugs, bisphosphonates, biologics, and antibiotics, are promising options for alleviating the disease.
47 citations
TL;DR: Improved understanding of the underlying etiopathogenesis of PPP has led to advances in treatment options, and targeted therapies for PPP have been evaluated or are under evaluation against more than 12 molecules in ongoing clinical trials.
Abstract: Palmoplantar pustulosis (PPP) is a chronic, recurrent skin disease belonging to the spectrum of psoriasis. It is characterized by an eruption of sterile pustules on the palms and soles. Recent studies in PPP have focused on genetic differences between pustular phenotypes and the role of the innate immunological system and the microbiome in the etiopathogenesis of the disease. Mutations in IL36RN (a major predisposing factor for generalized pustular psoriasis) were found in selected patients with PPP and were associated with earlier disease onset. Studies have shown that the interleukin (IL)-17 and IL-36 pathways might be involved in the pathogenesis of PPP. A microbiome has been demonstrated in the vesicopustules of PPP, and an abundance of Staphylococcus appears to be increased by smoking. Improved understanding of the underlying etiopathogenesis of PPP has led to advances in treatment options, and targeted therapies for PPP have been evaluated or are under evaluation against more than 12 molecules in ongoing clinical trials. These targets include CXCR2 (IL-8 receptor type B), granulocyte colony-stimulating factor receptor, IL-1 receptor, IL-8, IL-12, IL-23, IL-17A, IL-17 receptor, IL-36 receptor, phosphodiesterase-4, and tumor necrosis factor-α.
46 citations
TL;DR: The diagnosis, screening and treatment of patients with Palmoplantar pustulosis are explored, and 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.
Abstract: 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.
23 citations
TL;DR: The key data limitations identified include inconsistent definitions for characterizing remission/relapse, and limited humanistic and economic burden data; future studies are required to address these evidence gaps.
Abstract: Introduction: Palmoplantar pustulosis (PPP) is a chronic, relapsing and refractory disease characterized by sterile pustules appearing on the palms and/or soles, accompanied by erythema, blistering, scales and/or keratinization. The overall burden of PPP in terms of its clinical impact, effect on patients and families, and economic consequences has not previously been investigated in a structured manner.Areas covered: A structured search focused on identification of studies in PPP using specific search terms in PubMed and EMBASE® from 2005 onwards, with additional back-referencing and pragmatic searches. Outcomes of interest included clinical burden, humanistic burden, and economic burden.Expert opinion: In cross-sectional studies, approximately 75% of all PPP patients suffer from active disease, with risk of relapse remaining constant over time. Patients' health-related quality of life is significantly impaired, as expected for a disease affecting hands and feet. Tools have been described that assess the clinical as well as patient-reported burden of PPP; their performance in larger cohorts and/or clinical trials remains to be investigated. The key data limitations identified include inconsistent definitions for characterizing remission/relapse, and limited humanistic and economic burden data; future studies are required to address these evidence gaps.
11 citations
TL;DR: Three cases of new-onset palmoplantar pustulosis (PPP) are reported, involving a 26-year-old female patient with plaque psoriasis that was unsuccessfully pre-treated with fumaric ester acid, and therapy using the IL17RA antagonist, brodalumab, and the patient developed pustules on both palms and on both feet diagnosed as paradoxical PPP.
Abstract: Paradoxical drug reactions are defined as manifestation or unexpected exacerbation of a disease that is known to respond to a particular drug. The most commonly observed paradoxical drug reaction to TNF-blockers is psoriasiform dermatitis including its pustular variants [1]. Under therapy with IL17A or IL17RA blockers, manifestation of pustular variants has only been reported in three cases [2-4]. Here, we report three cases of new-onset palmoplantar pustulosis (PPP). Case 1 was a 26-year-old female patient with plaque psoriasis that was unsuccessfully pre-treated with fumaric ester acid, and therapy using the IL17RA antagonist, brodalumab, was started. PASI at the beginning of brodalumab treatment was 21.9 and improved to 4.5 after 12 weeks. However, eight weeks after initiation, several pustules manifested on both palms and started to appear on both soles without any known trigger. The diagnosis of PPP was made and the severity was rated with a score of 1 based on Pustulosis Palmoplantaris Physician General Assessment (PPGA 1) (6-point scale from 0-5) (figure 1A, B). Topical treatment with potent corticosteroids was started. Six weeks later, a flare of PPP on both hands and soles occurred (PPGA 4) while plaque psoriasis remained stable (figure 1C, D). Topical psoralen (P)UVA-therapy was added for three weeks, and PPP improved to PPGA 1. After a relapse of plaque psoriasis (PASI 8.8) seven weeks later, brodalumab was switched to ustekinumab, and within 16 weeks, PPP completely resolved and PASI improved to 0.6. Case 2 was a 44-year-old obese female patient with plaque psoriasis and confirmed PsA. During a treatment with adalimumab, joint symptoms persisted while plaque psoriasis was only mildly present. Adalimumab was replaced by secukinumab at a dose licensed for plaque psoriasis. Secukinumab therapy led to an improvement of joint symptoms, and plaque psoriasis remained well controlled (mean PASI <3). After 16 months of treatment, the patient developed pustules on both palms and, later on, on both feet diagnosed as paradoxical PPP (PPGA 1). Lesions worsened despite topical therapy with potent corticosteroids (PPGA 2). Four months later, secukinumab was discontinued. All signs of PPP resolved within four weeks without any systemic treatment. Case 3 was a 45-year-old female patient, a smoker with a BMI of 29.2. The patient had mild plaque psoriasis since childhood and developed severe psoriatic arthritis at the age of 43 years. After ineffective therapy with methotrexate, secukinumab was started at a dose licensed for PsA, A B
10 citations
TL;DR: The successful treatment of PPP with tofacitinib in three patients, one of which was a paradoxical PPP induced by TNFblocker therapy is reported, and symptoms of wrist arthritis resolved, while pain in the sternoclavicular joints showed only moderate improvement.
Abstract: Dear Editor, Palmoplantar pustulosis (PPP) is a rare disease affecting the palmoplantar regions characterized by sterile pustules mostly on erythematous ground. The Janus kinase (JAK) inhibitor tofacitinib has been approved for ulcerative colitis, rheumatoid arthritis and for psoriatic arthritis in combination with methotrexate and has also shown a moderate effect on plaque-type psoriasis. So far, a successful therapy of PPP with tofacitinib has been reported in three cases, one of which was a paradoxical PPP induced by TNFblocker therapy. On the other hand, manifestation of PPP under tofacitinib therapy has been reported in one patient. Here we report on the successful treatment of PPP with tofacitinib in three patients (Tables 1 and 2). Case 1 is a 70-year-old female ex-smoker in whom PPP and mild plaque psoriasis had manifested 4 years previously. Previous systemic therapies of PPP were all discontinued due to inefficacy (partly described as patient 1 in Pinter et al). Then tofacitinib 5 mg twice daily was started combined with methotrexate 2.5 mg/week orally. Palmoplantar Pustulosis Area and Severity Index (PPPASI) improved from 18.6 before therapy to 1.8 at week 12 (Figure 1A-C) and plaquetype psoriasis resolved. Case 2 is a 30-year-old female smoker in whom synovitis-acne-pustulosa-hyperostosis-osteitis (SAPHO) syndrome manifested 12 years earlier. Previous systemic therapies could not control her skin disease. Tofacitinib therapy (5 mg twice daily) in combination with methotrexate (10 mg s.c. weekly) was started. Palmoplantar Pustulosis Physician Global Assessment (PPGA) decreased from 3 before therapy to 1 after 12 weeks and 14 months of therapy (Figure 1D-F). Symptoms of wrist arthritis resolved, while pain in the sternoclavicular joints showed only moderate improvement. Case 3 is a 67-year-old male never-smoker who manifested with PPP and psoriasis vulgaris at the age of 45. He also suffered from psoriatic arthritis, ulcerative colitis and a demential syndrome. As vedolizumab combined with oral prednisolone could not control ulcerative colitis, vedolizumab was discontinued and tofacitinib 5 mg twice
9 citations
TL;DR: A comparison study by immunofluorescence and a method for estimating the probability of adverse drug reactions in patients receiving first-line bevacizumab-based therapy for glioblastoma multiforme found that the former is more accurate than the latter.
Abstract: 1. Kanat O, Ertas H. Existing anti-angiogenic therapeutic strategies for patients with metastatic colorectal cancer progressing following first-line bevacizumab-based therapy. World J. Clin. Oncol. 2019; 10: 52–61. 2. Belum VR, Cercek A, Sanz-Motilva V et al. Dermatologic adverse events to targeted therapies in lower GI cancers: clinical presentation and management. Curr. Treat. Options Oncol. 2013; 14: 389–404. 3. Keenan BP, Abuav R. Acneiform eruption in a patient receiving bevacizumab for glioblastoma multiforme. Arch. Dermatol. 2010; 146: 577. 4. Naranjo CA, Sellers EM, Sandor P et al. A method for estimating the probability of adverse drug reactions. Clin. Pharmacol. Ther. 1981; 30: 239–45. 5. Man XY, Yang XH, Cai SQ et al. Expression and localization of vascular endothelial growth factor and vascular endothelial growth factor receptor-2 in human epidermal appendages: a comparison study by immunofluorescence. Clin. Exp. Dermatol. 2009; 34: 396–401. doi: 10.1111/ajd.13117
9 citations
TL;DR: Generalized pustular psoriasis initially presenting as palmoplantar lesions may be misdiagnosed as PPP, and the presence of IL36RN mutation may serve to predict or confirm the diagnosis of future generalized pustulosis or acrodermatitis continua of Hallopeau.
Abstract: We retrospectively analyzed 66 patients with palmoplantar pustulosis (PPP) from January 1994 to September 2019 in our department. Interleukin-36 receptor antagonist gene (IL36RN) intron 3 c.115+6T>C mutation was present in two out of 27 patients (7.4%). Both cases developed generalized pustular psoriasis and/or acrodermatitis continua of Hallopeau later. Topical medications and phototherapy were used in 93.9% and 28.8% of patients, respectively, while 60.6% received systemic agents. The majority of patients (60.6%) responded to treatment, but episodes of flare-up existed. The demographic data of our patients with PPP showed female predominance (59.1%), middle-age onset (44.2 years old) and current smokers (62.1%). Generalized pustular psoriasis initially presenting as palmoplantar lesions may be misdiagnosed as PPP, and the presence of IL36RN mutation may serve to predict or confirm the diagnosis of future generalized pustular psoriasis or acrodermatitis continua of Hallopeau. To our knowledge, this is the largest demographic study of PPP in Taiwan.
8 citations
TL;DR: An update of a previously reported case of severely recalcitrant PPP successfully treated with the Janus kinase (JAK) inhibitor tofacitinib is reported.
Abstract: Tumor necrosis factor (TNF) inhibitor–induced palmoplantar pustulosis (PPP) can present with debilitating, refractory disease that requires changing or stopping anti-TNF agents or adding systemic treatments. Here, we report an update of a previously reported case of severely recalcitrant PPP successfully treated with the Janus kinase (JAK) inhibitor tofacitinib.
8 citations
TL;DR: This paper describes a case of a refractory palmoplantar pustulosis succesfully treated with apremilast, an oral phosphodiesterase-4 inhibitor approved for the treatment of chronic plaque psoriasis and psoriatic arthritis.
Abstract: Palmoplantar pustulosis is a chronic inflammatory disease which characterized by a eruption of sterile pustules on the palms and soles. Apremilast is an oral phosphodiesterase-4 inhibitor which is approved for the treatment of chronic plaque psoriasis and psoriatic arthritis. However, no clinical trial has been performed to confirm the efficacy of apremilast for palmoplantar pustulosis yet. Moreover, there are very few cases of this disease treated with apremilast. Herein, we describe a case of a refractory palmoplantar pustulosis succesfully treated with apremilast.
TL;DR: The first double-blinded randomized placebo-controlled trial of guselkumab for PPP has been completed and the drug was effective, and guselKumab could be used as a new agent for P PP treatment, in addition to several conventional therapeutics.
Abstract: Palmoplantar pustulosis, or pustulosis palmaris et plantaris (PPP), is a chronic, recurrent inflammatory skin disease that is sometimes unresponsive to conventional therapy. The anti-interleukin 23...
TL;DR: Patients with Palmoplantar pustulosis require multidirectional tests, since finding the cause of the disease is essential to administering effective treatment.
Abstract: Palmoplantar pustulosis (PPP) is a chronic inflammatory disease, most often occurring in middle-aged women. In the course of the condition, painful skin lesions appear on the hands and feet, i.e., areas that are extremely important in everyday life. Therefore, the disease significantly reduces quality of life. The pathogenesis of this disease is poorly understood, although it is known that genetic, immunological and environmental factors play a role in its development. Clinical observations confirm the role of nicotine and contact allergens in the development of the lesions. The skin lesions can also occur as a side effect of certain medications. In some cases, PPP coexists with other diseases, i.e., seronegative arthropathies, as well as celiac and thyroid diseases. There is also a connection between the disease and infectious bacterial foci. Exacerbation of the skin lesions is triggered by stress. Therefore, patients require multidirectional tests, since finding the cause of the disease is essential to administering effective treatment.
TL;DR: A 58-year-old woman with SAPHO developed paradoxical psoriasiform lesions and exacerbation of primary palmoplantar pustulosis after 7 weeks of etanercept treatment and received TwHF treatment, which resulted in rapid and remarkable improvement in her skin lesions and osteoarticular pain.
Abstract: Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare autoinflammatory disorder without standardized therapy. Anti-tumor necrosis factor (TNF)-α agents, which have been widely used in recent treatment of SAPHO syndrome, may elicit severe paradoxical psoriasiform lesions. Therefore, physicians must reverse the paradoxical skin lesions in affected patients, while improving their clinical symptoms of SAPHO syndrome. Herein, we describe a patient with SAPHO who exhibited TNF-α antagonist-induced paradoxical skin lesions and benefitted from treatment with Tripterygium wilfordii hook f (TwHF). A 58-year-old woman with SAPHO developed paradoxical psoriasiform lesions and exacerbation of primary palmoplantar pustulosis after 7 weeks of etanercept treatment. She then received TwHF treatment, which resulted in rapid and remarkable improvement in her skin lesions and osteoarticular pain. These findings suggest that TwHF might be a suitable treatment option for patients with SAPHO who exhibit TNF-α antagonist-induced paradoxical skin lesions.
TL;DR: Paloplantar pustulosis appears to be a distinct entity from psoriasis, and routine thyroid functions test could be analyzed, but patch testing is not required in patients with palmoplantars pustULosis.
Abstract: Background Palmoplantar pustulosis is a chronic and relapsing disease of the palms and soles, which is characterized by scattered clusters of pinhead-sized, sterile pustules. Objective The aim of the present study was to determine demographic features, co-morbidities, and relation of palmoplantar pustulosis with psoriasis. Methods A total of 48 patients (M/F: 15/33) were enrolled in the present study. A detailed history regarding age of onset, palmoplantar pustulosis duration, number of recurrences, personal and family history of psoriasis, accompanying arthritis, sternoclavicular tenderness, dental fillings, smoking status, and autoimmune disease was obtained; thorough dermatological examination was carried out. Patch testing results and laboratory investigations for thyroid autoimmunity were recorded. Results Thirty-five of 48 patients (72.9%) were current smokers. Twenty of the 48 patients (41.7%) had dental fillings. There was not any significant correlation between palmoplantar pustulosis duration and dental filling duration (p = 0.170). Psoriasis was not detected in any patients either in history or in dermatological examination. Nail involvement and joint complaints were observed in seven of 48 patients (14%) and in nine of 48 patients (18%), respectively. Autoimmune thyroiditis was observed in four of 48 patients (12%). Patients with patch testing positivity (12.5% of patients, M/F: 1/5) had no considerable association for history of external contact with these materials. Study limitations Retrospective analysis. Conclusion Palmoplantar pustulosis appears to be a distinct entity from psoriasis. Routine thyroid functions test could be analyzed, but patch testing is not required in patients with palmoplantar pustulosis. Also, patients with palmoplantar pustulosis must be evaluated for musculoskeletal symptoms and signs.
TL;DR: Rinsing the periodontal area with ONB water resulted in very effective suppression of skin lesions and showed promise as a new treatment method for palmoplantar pustulosis, which suggested the involvement of oral bacteria.
Abstract: Neither the etiology nor a reliable treatment for palmoplantar pustulosis has been clearly established Ozone nanobubble (ONB) water, which is treated with nanosized ozone gas particles and has strong antimicrobial activity, has attracted attention as a future therapeutic option for palmoplantar pustulosis Oral rinsing, particularly in the periodontal areas, with 10 to 20 mL ONB water for a couple of minutes per night, was prescribed to seven palmoplantar pustulosis patients, comprising five female and two male patients, for 6 months Skin lesions were observed to be completely cured within a treatment period of approximately 3 to 4 months in six patients; the exception case was the one suspected of having pyorrhea Rinsing the periodontal area with ONB water resulted in very effective suppression of skin lesions and showed promise as a new treatment method for palmoplantar pustulosis, which suggested the involvement of oral bacteria
TL;DR: A case of PPP with spondylitis-type PAO with 20-years' duration, which dramatically improved after a single use of guselkumab is described.
Abstract: Dear Editor, Pustulotic arthro-osteitis (PAO) is a refractory condition associated with palmoplantar pustulosis (PPP), which affects the sternocostoclavicular joints in over 80% of the cases. A new biologic, guselkumab, is shown to be effective for not only PPP but also PAO in a phase 3 study. However, its effect on joint manifestation other than anterior chest wall areas is yet unknown in a real-world setting. Herein, a case of PPP with spondylitis-type PAO with 20-years' duration, which dramatically improved after a single use of guselkumab is described. A 66-year-old female with PPP and PAO was referred to our department. She was suffering from PPP and severe joint pain for 20 years, which appeared almost simultaneously, and had been treated without satisfactory results. She was a smoker (20 cigarettes a day for 25 years), but quit smoking soon after she was diagnosed as having PPP. Dental treatment was already completed, and examination for focal infections such as tonsillitis was normal. Physical examination showed palmoplantar erythema with scales as well as a small number of pustules and vesiculopustules (Figure 1A). Scaly erythemas were scattered on the lower legs. A biopsy specimen from the plantar
Journal Article•
TL;DR: In this rare case, it is difficult to identify the exact cause of the improvement in PPP; thus, further studies are required to clarify the mechanism of remission.
Abstract: Metal allergy is an uncommon problem during surgery. Among them, titanium allergy is said to be rare, but can lead to serious complications, such as palmoplantar pustulosis (PPP). A 69-year-old woman was admitted to our hospital with a chief complaint of chest pain. Coronary angiography showed severe coronary artery disease that required coronary artery bypass grafting (CABG). The patient had a history of orthopedic surgery for left distal radius fracture 2 years previously, which resulted in inflammation on the left arm and PPP. We suspected titanium allergy based on results of skin patch tests and use of titanium alloy in the previous orthopedic operation. The patient underwent CABG without use of permanent metallic material. As a result, her PPP disappeared. In this rare case, it is difficult to identify the exact cause of the improvement in PPP; thus, further studies are required to clarify the mechanism of remission.
TL;DR: Hyperketonemia increases tumor necrosis factor-alpha secretion in cultured U937 monocytes and type 1 diabetic patients and is apparently mediated by oxidative stress and cAMP deficiency.
Abstract: 325 8. Jain SK, Kannan K, Lim G, McVie R, Bocchini JA Jr.. Hyperketonemia increases tumor necrosis factor-alpha secretion in cultured U937 monocytes and type 1 diabetic patients and is apparently mediated by oxidative stress and cAMP deficiency. Diabetes 2002; 51: 2287-93. 9. Böer A, Misago N, Wolter M, Kiryu H, Wang XD, Ackerman AB. Prurigo pigmentosa: a distinctive inflammatory disease of the skin. Am J Dermatopathol 2003; 25: 117-29.
TL;DR: The case of a woman experiencing severe left thigh acute pain and having a medical history of palmoplantar pustulosis is reported, demonstrating that knowledge of atypical radiologic findings is necessary to diagnose initial SAPHO syndrome.
Abstract: Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare inflammatory disorder with multiple phenotypes. The syndrome has identifiable radiologic characteristics that are the most important when making a diagnosis. X-rays of cases diagnosed with SAPHO syndrome reveal sclerotic lesions or mixed lytic and sclerotic lesions. Pure osteolytic lesions in SAPHO syndrome are rare, and to the best of our knowledge, no study has reported the radiologic change of purely osteolytic lesions to osteosclerotic lesions over time. Herein, we report on the case of a woman experiencing severe left thigh acute pain and having a medical history of palmoplantar pustulosis. Although SAPHO syndrome was suspected because of palmoplantar pustulosis, based on radiologic findings, bone metastasis of a malignant tumor or chronic bacterial osteomyelitis owing to a purely osteolytic lesion was suspected. However, needle biopsy revealed no malignancy and bacterial culture was negative, thus suggesting SAPHO syndrome. Nonsteroidal anti-inflammatory drugs, bisphosphonates, and corticosteroids were administered, which improved the left thigh pain. Furthermore, the radiologic change of osteolytic lesions to osteosclerotic lesions over time was confirmed, leading to the diagnosis of SAPHO syndrome. Our case demonstrates that knowledge of atypical radiologic findings is necessary to diagnose initial SAPHO syndrome.
TL;DR: Compound Qinjiao Pill combined with 308 nm excimer laser can reduce the NLR in peripheral blood, improve the clinical efficacy and reduce the risk of recurrence.
Abstract: Objective
To evaluate the efficacy of compound Qinjiao Pill in the treatment of pustulosis palmaris and plantaris and the effect on the neutrophil-to-lymphocyte ratio (NLR).
Methods
A total of 100 patients with palmoplantar pustulosis who met the inclusion criteria from June 2017 to June 2018 were randomly divided into two groups, 50 in each group. The control group was treated with 308 nm excimer laser twice a week, and the treatment group was treated with one compound Qinjiao Pill once and twice a day. Both groups were treated for 8 weeks and followed up for 3 months. The disease severity was evaluated by the Palmoplantar pustulosis area and severity index (PPPASI), the quality of life was evaluated by the dermatology life quality index (DLQI), the changes of serum NLR were observed, and the clinical efficacy was evaluated.
Results
The total effective rate was 88.0% (44/50) in the treatment group and 70.0% (35/50) in the control group. The PPPASI scores (t=6.813, 3.091, 3.582, 5.622) and DLQI scores (t=5.713, 4.616, 6.262, 1.824) in the treatment group were significantly lower than those in the control group (P<0.01). After treatment, NEU (4.13 ± 1.42 ×109/L vs. 6.56 ± 1.65 ×109/L, t=7.893), NLR (1.75 ± 0.98 vs. 2.60 ± 0.87, t=4.592). During the treatment, the incidence of adverse reactions was 20.0% (10/50) in the treatment group and 18.0% (9/50) in the control group (χ2=1.680, P=0.089). The recurrence rate of the treatment group was 9.1% (4/44) and that of the control group was 20.0% (7/35). The difference between the two groups was statistically significant (χ2=2.893, P=0.003).
Conclusions
Compound Qinjiao Pill combined with 308 nm excimer laser can reduce the NLR in peripheral blood, improve the clinical efficacy and reduce the risk of recurrence.
Key words:
Impetigo; Qinjiao Pill; Lasers, excimer; Neutrophil-to-lymphocyte ratio
TL;DR: A 29-year-old woman came to the authors' clinic in December 2014 complaining of pustules on her palms and soles, bone pain, and BME, and was diagnosed with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome.
Abstract: A 29-year-old woman came to our clinic in December 2014 complaining of pustules on her palms and soles (Figs. 1A, B) with nail changes (Figs. 1C, D) and erythematous scaly plaques on her scalp, hips, and thighs. She also noted pain in the sternoclavicular joints and lumbosacral region. Magnetic resonance imaging (MRI) revealed long T2 signals on the sacral side of the left sacroiliac joint, indicating bone marrow edema (BME; Fig. 2A). Based on the findings of palmoplantar pustulosis, bone pain, and BME, the patient was diagnosed with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. She was successively treated with nonsteroidal anti-inflammatory drugs, minocycline, glucocorticoid, and Tripterygium wilfordii, which were all ineffective in controlling her symptoms. The patient reported that she had severe acute attacks of tonsillitis 2 to 3 times a year during 21 to 24 years of age, and had persistent sore throat after then. Physical examination revealed bilateral tonsillar swelling (degree I) with purulent exudate. Due to recurrent pharyngitis, bilateral tonsillectomy was performed in November 2015. After the surgery, she experienced a severe outbreak of pustules on her palms and soles, which diminished spontaneously after 2 weeks. One month after the surgery, MRI revealed significant improvements of the BME at the left sacroiliac joint
30 Aug 2020
TL;DR: A 54-year-old woman who presented with a painful pustular lesion on her right palm was diagnosed with palmoplantar pustulosis and switched to halobetasol propionate 0.01% and tazarotene 0.045% lotion, a novel corticosteroid–retinoid combination, while awaiting payor approval for systemic biologic therapy.
Abstract: Background:Psoriasis is a chronic inflammatory disease that affects skin and joints and is associated with numerous comorbidities. There are several clinical subtypes including the uncommon pustula...
TL;DR: Japanese guidelines for the management and treatment of generalized pustular psoriasis: the new pathogenesis and treatmentof GPP are published.
Abstract: 1 Hoegler KM, John AM, Handler MZ, Schwartz RA. Generalized pustular psoriasis: a review and update on treatment. J Eur Acad Dermatol Venereol 2018; 32: 1645–1651. 2 Fujita H, Terui T, Hayama K et al. Japanese guidelines for the management and treatment of generalized pustular psoriasis: the new pathogenesis and treatment of GPP. J Dermatol 2018; 45: 1235– 1270. 3 Ishikawa G, Dua S, Mathur A et al. Concomitant interstitial lung disease with psoriasis. Can Respir J 2019; 2019: 1–9. 4 Napolitano M, Megna M, Balato A et al. Systemic treatment of pediatric psoriasis: a review. Dermatol Ther 2016; 6: 125–142. 5 Takahashi M, Takeuchi M, Matsunaga K. Infant with generalized pustular psoriasis who responded to cyclosporin A therapy. J Dermatol 2015; 42: 911–913.
TL;DR: A patient with SAPHO syndrome is described for whom bilateral tonsillectomy was effective for the treatment of arthralgia, which was quantified using multiple pain scales.
Abstract: Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome has been proposed to describe a clinicoradiological entity manifesting in the joints, skin and bones. We describe a patient with SAPHO syndrome for whom bilateral tonsillectomy was effective for the treatment of arthralgia, which was quantified using multiple pain scales.
01 Jan 2020
TL;DR: Ultraviolet B radiation has been used in the treatment of different immunomediated skin diseases and only mild side effects have been reported.
Abstract: Ultraviolet B radiation has been used in the treatment of different immunomediated skin diseases. Different clinical studies reported the use of excimer lasers and lights in a wide variety of chronic and resistant localized dermatoses. These comprise psoriasis, palmoplantar pustulosis, vitiligo, mycosis fungoides, alopecia areata, genital lichen sclerosus, prurigo nodularis, localized scleroderma, and granuloma annulare. Only mild side effects have been reported.
Patent•
02 Jul 2020TL;DR: In this article, the treatment of or alleviation of signs and symptoms of palmoplantar pustulosis with anti-IL-36R antibodies in a patient was described.
Abstract: The present invention relates to the treatment of or alleviation of signs and symptoms of palmoplantar pustulosis (PPP) with anti-IL-36R antibodies in a patient.
Patent•
11 Jun 2020
TL;DR: The present disclosure relates to a method for reducing circulating neutrophils in a subject without causing sustained grade 3 or grade 4 neutropenia as mentioned in this paper, and also relates to methods for treating neutrophilic conditions with an antibody that inhibit G-CSF signalling.
Abstract: The present disclosure relates to a method for reducing circulating neutrophils in a subject without causing sustained grade 3 or grade 4 neutropenia The present disclosure also relates to methods for treating neutrophilic conditions with an antibody that inhibit G-CSF signalling In particular, the present disclosure relates to methods of 5 treating neutrophilic dermatoses, such as hidradenitis suppurativa (HS) and palmoplantar pustulosis (PPP)