Interventions for chronic palmoplantar pustulosis (Review)

Summary Background Palmoplantar pustulosis (PPP) is a chronic inflammatory disease in which sterile and relapsing pustules appear on the palms and soles. Objectives To assess the effects of interventions for chronic PPP to induce and maintain complete remission. Methods We searched for randomized controlled trials (RCTs), including people with PPP or chronic palmoplantar pustular psoriasis, in the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, LILACS and eight trials registers up to July 2020. Study selection, data extraction and risk‐of‐bias assessment were carried out independently by two review authors. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. Results We included 37 RCTs (1663 participants, 76% women, mean age 50 years). Mean treatment duration was 11 weeks. Topical vitamin D derivative may be more effective than placebo in achieving clearance [risk ratio (RR) 7·83, 95% confidence interval (CI) 1·85–33·12; low‐certainty evidence from two trials]. Concerning biological therapies, there was little or no difference between etanercept and placebo in achieving clearance (low‐certainty evidence from one trial), ustekinumab is less effective than placebo in reducing severity (low‐certainty evidence from one trial), and guselkumab (RR 2·88, 95% CI 1·24–6·69) and secukinumab (RR 1·55, 95% CI 1·02–2·35) are probably better in reducing disease severity (moderate‐certainty evidence from two and one trial(s), respectively) but may cause more serious adverse events than placebo. Conclusions Evidence is lacking for or against major chronic PPP treatments. Risk of bias and imprecision limit our confidence in the results.

Background: Lichen sclerosus (LS) is a chronic, inflammatory dermatosis. Initial treatment with superpotent topical corticosteroids is the accepted and evidence-based first-line therapy. For those who do not respond after exclusion of other potentiating factors, the best second-line therapy is unclear. Laser therapy is an emerging treatment for genital LS and despite uncertain efficacy its use is gaining popularity in the private sector. Objectives: We aimed to review the effectiveness of laser therapy for genital LS in men, women and children. Methods: We conducted a systematic review of all primary studies reporting the use of laser in genital LS. Ovid MEDLINE, PubMed, Ovid Embase, Cochrane CENTRAL, Web of Science, CINAHL and PsycINFO were searched from inception to February 2021. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials, ROBINS-I tool for non-randomized trials and Joanna Briggs Institute checklist for case studies. Results: A total of 24 studies, involving 616 adults, met inclusion criteria. These were six randomized controlled trials (RCTs), one non-randomized trial, nine single arm trials and eight case series. Where assessed, most studies suggest that laser therapy in patients with LS may improve symptoms, clinical signs, quality of life and sexual function. However, results were highly heterogeneous and methodological quality was very low, therefore meta-analysis was not possible. Conclusions: There is poor evidence to support the use of laser therapy for genital LS at present. Effectiveness of laser needs to be robustly investigated in well-conducted RCTs. | INTRODUCTIONLichen sclerosus (LS) is a chronic, inflammatory dermatosis, with predilection for genital skin. The incidence of LS is 1.6% in women by age 80. 1 Symptoms include intense itch, soreness and dyspareunia. Anatomical changes with resorption of the labia minora and fusion of the clitoral hood can occur. Scarring from dermal inflammation causes anatomical alteration. In males, LS typically occurs on the glans penis and foreskin, leading to phimosis, difficulty with micturition and dyspareunia. 2 LS also affects children although this is less common. LS has considerable impact on quality of life and psychosocial and sexual well-being. 3,4 In addition, a small proportion (3%-5%) develop malignancy. [5][6][7] First-line treatment with super-potent topical corticosteroids is the accepted evidence-based therapy. 8This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Interventions for chronic palmoplantar pustulosis (Review)