Palmoplantar pustulosis: Current understanding of disease definition and pathomechanism.

Pustulosis palmaris et plantaris, or palmoplantar pustulosis (PPP), is a chronic pustular dermatitis involving the palms and soles and is characterized by vesicles, pustules, erythema, lichenification, and abnormal desquamation. It is one of the most common skin diseases in Japan but its pathomechanism is unclear and the disease remains poorly defined. Consequently, adequate treatment for PPP is lacking. As a localized type of pustular psoriasis, PPP has long been treated with the conventional therapies used for plaque-type psoriasis, especially in Western countries. However, PPP may be a distinct entity, with a much lower prevalence in Western countries than in Japan. Furthermore, while treatment has yielded insights into the underlying pathology in plaque-type psoriasis, the pathogenesis of PPP has yet to be elucidated. In 2018, Gulselkumab, a monoclonal antibody against interleukin (IL)-23, was certified for use in Japan and is the first biologic effective in PPP both in Japanese and other patients. In this review, we summarize the current understanding of PPP, including the revised definition and possible pathomechanism. The information presented herein provides a more complete picture of PPP and may facilitate the development of improved treatment options.

Coix-seed Reactive Derivatives(CRD): An Observational study / 日本補完代替医療学会誌

Functional food research encompasses several types of study designs, including observational studies and randomized clinical trials (RCTs). To clarify the functions of Coix-seed Reactive Derivatives(CRD), we observed 7 refractory skin diseases: case1 Pustulosis palmaris et plantaris, case2 atopic dermatitis, case3 hand eczema, case4 contact dermatitis, case5 wrinkles of a face, case6 acne vulgaris and case7 lentigo senilis(senile pigment freckle). Although CRD intake seemed to be effective in all cases, further studies are needed to define the optimal dose and duration.

Psoriasis pustulosa palmar unilateral: A propósito de un caso / Unilateral palmar pustular psoriasis: A clinical case

La psoriasis pustulosa palmoplantar (PPP) es una enfermedad inflamatoria crónica y recurrente, caracterizada por la presencia de pústulas estériles, sobre una base eritematosa en palmas y plantas. Es de gran importancia, debido a que ocasiona tanto limitación funcional como disminución en la calidad de vida, siendo en la mayoría de los casos refractaria al tratamiento. Se presenta un caso de PPP, donde fueron necesarias aplicar terapias combinadas: tópica y sistémica (esteroides de alta potencia y ciclosporina), con evolución satisfactoria en cuatro semanas de tratamiento. Se realizó una revisión exhaustiva en los motores de búsqueda como: Latindex.org, Scielo.org y Google académico, de las publicaciones más representativas hasta la actualidad y las palabras clave, a través de la web de Medical Subject Headings.

Palmoplantar Pustular Psoriasis (PPP) is a chronic and recurrent inflammatory disease, characterized by the presence of sterile pustules on an erythematous base in palms and soles. It is important because it causes both functional limitation decreasing quality of life. In most cases refractory to treatment. We present a case of PPP with topical and systemic combined therapy (high potency corticoids and cyclosporine) with satisfactory outcomes at four weeks of treatment. An exhaustive review in search engines as Scholar Google, Latindex and Scielo was made for the last 30 years and key words in Medical Subject Headings.

Detection of tumor necrosis factor-α, interleukin-17,-22 and-17F in sera from patients with palmoplantar pustulosis / 中华皮肤科杂志

Objective To determine the serum levels of tumor necrosis factor (TNF)-α,interleukin (IL)-17,IL-22 and IL-17F in patients with palmoplantar pustulosis (PP),and to estimate their relationship with disease activity in PP.Methods Venous blood samples were collected from 30 patients with PP at both active stage and stationary stage and from 20 healthy human controls.Enzyme-linked immunosorbent assay (ELISA) was conducted to determine the serum levels of TNF-α,IL-17,IL-22 and IL-17F.The paired Wilcoxon signed rank test was carried out to compare the serum levels of cytokines between patients at active stage and at stationary stage,and the Mann-Whitney U test to compare those among different groups.Results The median serum levels of TNF-α,IL-17 and IL-22 in patients with PP at active stage were 186.35 (range,113.48-412.69) ng/L,420.45 (range,278.55-748.73) ng/L and 106.48 (range,69.13-251.86) ng/L respectively,significantly higher than those at stationary stage (42.52(18.83-95.37) ng/L,48.11 (36.43-80.04) ng/L,20.32 (10.55-48.75) ng/L,respectively,all P ＜ 0.05) and those in the controls (24.30 (12.0-61.56) ng/L,10.49 (6.24-24.44) ng/L,2.58 (1.41-5.78) ng/L,respectively,all P ＜ 0.05).Moreover,the patients at stationary stage showed a significant elevation in serum levels of TNF-α,IL-17 and IL-22 compared with the controls (u =2.71,3.53,2.18,respectively,all P ＜ 0.05).No statistical difference was noted in the serum level of IL-17F among the patients at different stages and controls (P ＞ 0.05).Conclusion The circulating levels of TNF-α,IL-17 and IL-22 were associated with disease activity in PP,hinting that they may be involved in the development of PP.

Cutaneous small vessel vasculitis accompanied by pustulosis palmaris et plantaris.

We present the case of a 64-year-old woman who has suffered from pustulosis palmaris et plantaris for 10 years. At the first examination, many erythematous lesions with purpura, blood crusts, and blisters were present in the lower legs and dorsum of the feet. Painful swelling in the sternal region and dorsal pain were also noted. Elevation of the CRP and myogenic enzyme levels, and liver and renal dysfunctions were noted on blood testing. Histopathologically, leukocytoclastic vasculitis was noted in small blood vessels in the whole dermal layers, and deposition of IgM and C3 in the vascular wall was detected by the direct immunofluorescence techniques. Based on these findings, cutaneous small vessel vasculitis was diagnosed. Because the patient complained of a toothache during the clinical course, an X-ray examination was performed. On pantomography, a radicular cyst and apical periodontitis were noted. The tooth symptoms changed with exacerbation and remission of the skin symptoms. These findings indicate that odontogenic infection is very likely to be a cause of cutaneous small vessel vasculitis in a manner similar to pustulosis palmaris et plantaris.

Seven Casees of Local PUVA-bath Therapy in Nagoya City Midori Municipal Hospital / 日本温泉気候物理医学会雑誌

<B>Objective</B><BR>  PUVA therapy (combination of 8-methoxypsoralen and UVA irradiation) is commonly applied for treatment of psoriasis, pustulosis palmaris et plantaris and atopic dermatitis among dermatologists. PUVA bath therapy (PUVA soak therapy) is an arranged method of topical PUVA therapy, irradiate UVA just after soaking bath with 8-methoxypsoralen aqueous solution. It's speculated to cause less carcinogenesis and less general side effects than oral or classical topical PUVA therapy. The local PUVA bath therapy is an applied method of PUVA bath therapy which uses a wash-basin to soak hands or feet. This time 7 patients were treated with this method.<BR><B>Methods</B><BR>  Prepared in a wash-basin 0.0001% 8-methoxypsoralen in 37-40°C water and soaked lesion area for 15 minutes and irradiate UVA immediately after soaking. The UVA-radiation was done once every week. Started with UVA-dose of 0.5J/cm<SUP>2</SUP> for all patients, and increase doses by 0.5J/cm<SUP>2</SUP> for each therapy up to maximum single UVA-dose of 2.5 or 3.0J/cm<SUP>2</SUP>. 7 patients (age 41-76 years, 3 men and 4 women, 3 psoriasis vulgaris and 4 pustulosis palmaris et plantaris) treated with this therapy and total UVA-dose was ranging from 22.1to 63.5J/cm<SUP>2</SUP>.<BR><B>Results</B><BR>  One patient dropped out. Among the the remaining six patients, one patient showed no improvement and one other patient showed improvement but was relapsed just after the end of treatment. Four patients showed improvement and one of them (pustulosis palmaris et plantaris) have kept good condition over two years after treatment.<BR><B>Discussion</B><BR>  Local PUVA bath therapy is good treatment because it can be done easily to ambulatory patients if a UVA-lump is available, and some patients gain long-term remission.

A Study of Clinical Features of 50 Patients with Pustulosis Palmaris et Plantaris / 대한피부과학회지

BACKGROUND: Pustulosis palmaris et plantaris is a chronic inflammatory disease of the palms and soles, but its pathomechanism is still unclear. OBJECTIVE: The purpose of this study was to review the clinical features of patients with pustulosis palmaris et plantaris. METHODS: This study included 50 patients with pustulosis palmaris et plantaris who had visited the Department of Dermatology, Chonnam National University Hospital from April 1998 through to April 2003. We reviewed the medical records and biopsies, and analyzed information from patients by questionnaire. RESULTS: Among the 50 patients with pustulosis palmaris et plantaris, 34 patients (68%) were male and 16 patients (32%) were female, thus the ratio was approximately 2.1 : 1. The age of onset of lesions ranged from 16 to 71 years, and the mean age of onset was 43.9 years in males and 43.3 years in females. The prevalent age of onset was the fourth decade in males and the fifth decade in females. The frequent sites of involvement were the bilateral hands and feet. Psoriasis-like skin lesions were observed in 15 gap (30%) of patients, and nail involvement in 15 gap (30%) of the patients. The seasonal change did not influence the severity of the skin lesion. No direct relationship could be found between pustular eruptions and focal infections, such as tonsilitis. Fourteen males (41.2%) and 2 female patients (12.5%) had a history of smoking. Improvement of the lesions was obtained in all the patients, however, complete remission of the disease was achieved in only 6 gap (12%) of patients. All other patients experienced periodic relapses, despite treatment. CONCLUSION: Pustulosis palmaris et plantaris is a chronic relapsing disease that can greatly impair patient's quality of life, because of its chronic course and poor response to treatment.

A Clinical Investigation of Pustulosis Palmaris et Plantaris / 대한피부과학회지

A clinical investigation of the patients with pustulosis palmaris et plantaris (PPP) was made on 36 patients who were seen at the Department of Dermatology, Seoul National University Hospital, from January 1986 through June 1987. The results were summarized as follows : 1. In this series of 36 patients, 14 patients(38.9%) were male and 22 patients (61.1%) were female. Females are more subject to the affection than males. 2. The mean age of onset in male was 30.6 years and in female it was 38.4 years, indicating a earlier onset in male. The peak age of incidence in male was between 20 and 29 years and in female, between 40 and 49 years. 3. The sites of involvement were mostly bilateral hands and feet. 4. the season of the year did not influence the severity of the skin lesions in 68.9%. 5. Nine patients(28.1%) had psoriasis-like skin lesions and 14 patients(43.1%) had nail changes out of 32 patients with PPP. 6. No direct relationship could be found between pustular eruptions and focal infections, such as tonsilitis, otitis, dental abscess and sinusitis. 7. Remmission of the pustular eruptions could be achieved in 5 out of 10 patients treated with etretinate and in 4 out of 11 patients treated with ketoconazole for more than 4 weeks' treatment