Treatment for Palmoplantar Pustular Psoriasis REVIEW · August 01, 2014 TAKE-HOME MESSAGE A systemic review of articles on palmoplantar pustular psoriasis (PPPP) included a Cochrane review of 23 randomized controlled trials that recommended oral retinoid therapy, photochemotherapy, cyclosporine, or topical corticosteroids. There have been nine open studies since the Cochrane review that showed better efficacy with PUVA compared with UVB and some improvement with the Excimer 308-nm laser.There is a need for randomized controlled trials for PPPP. Recommendations for treatment of PPPP without psoriatic arthritis are as follows: First-line treatment—potent or very potent topical corticosteroids with occlusion during flares; second-line—combination of acitretin and local phototherapy; third-line—cyclosporine or methotrexate. Treatment recommendations for PPPP with psoriatic arthritis are slightly different and include a biological agent. – Sarah Churton, MD ABSTRACT BACKGROUND Palmoplantar pustular psoriasis (PPPP) is a variant of psoriasis whose the association with psoriatic arthritis (PsA) has been recently described. There is limited evidence regarding how to best reduce palmoplantar pustular psoriasis severity and to maintain remission once achieved. OBJECTIVE The aim of this study was to elaborate evidence-based recommendations for PPPP treatment supported by a systematic literature review. METHODS A systematic literature search was carried out in Embase, Medline and Cochrane Library databases from 1980 to February 2013 searching for any trial in patients with PPPP assessing therapeutic interventions not including a systemic biotherapy. The selection of articles was limited to human subjects and English or French languages. RESULTS Among the 675 articles identified, 29 including one Cochrane review were analysed. The Cochrane review summarised 23 randomised controlled trials (RCTs) in chronic PPPP until February 2003, including 724 patients. The authors concluded that oral retinoid therapy (acitretin), photochemotherapy or combination of both, low dose of ciclosporin or topical corticosteroids under occlusion appeared to be helpful in relieving symptoms of PPPP. Since the publication of this review, 9 open studies on PPPP treatment have been published. Three new studies evaluated the benefits of PUVA on PPPP. They all showed a better efficacy of PUVA compared to UVB therapy. One open study concluded that a retinoid treatment with an arotinoid ethylesther showed a good efficacy. Five prospective studies (level of evidence of 3) assessed Laser Excimer UVB-NB (Excimer 308 nm) in PPPP. The combined analysis of these studies showed that 64% of patients experienced an improvement of 70% at the end of treatment. CONCLUSION Phototherapy, ciclosporin and topical corticosteroids seem to be able to control PPPP. However, the standard of care for PPPP remains an issue and there is a strong need for reliable RCTs to better define treatment strategies for PPPP.
Posted on: Tue, 12 Aug 2014 16:51:58 +0000
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