Palmoplantar pustulosis: pathogenesis, differential diagnosis, and treatment - PubMed
6 hours ago
- #Psoriasis
- #Palmoplantar Pustulosis
- #Inflammatory Skin Disease
- Palmoplantar pustulosis (PPP) is a chronic inflammatory disease characterized by sterile pustules on palms and soles, impairing quality of life.
- Women are more frequently affected than men, and smoking is a major trigger. Paradoxical PPP can occur under biologic therapies, especially TNF antagonists.
- PPP is associated with psoriasis vulgaris and may involve osteoarticular symptoms.
- Pathogenesis likely starts around the acrosyringium, with pustules consisting of neutrophilic granulocytes attracted by chemotactic factors from activated keratinocytes.
- Inflammation is sustained by a self-amplifying cytokine network including IL-17 and IL-19.
- Treatment includes topical treatments, UV-phototherapies (especially topical PUVA), and systemic therapies.
- Systemic agents include conventional treatments (acitretin, methotrexate, fumaric acid esters, ciclosporin), newer small molecules (apremilast, JAK inhibitors), and biologics.
- Conventional systemic therapies are often insufficient and have side effects; only acitretin is currently approved for PPP.
- Recent placebo-controlled studies show significant effects of apremilast, brodalumab, guselkumab, and risankizumab on PPP.
- Further studies with topical and systemic JAK inhibitors and IL-17A/F inhibitors are underway.