Efficacy of Granulocyte and Monocyte Adsorption Apheresis for Treatment of Palmoplantar Pustulosis

Fujisawa, Tomomi; Tawada, Chisato; Mizutani, Yoko; Doi, Tomoaki; Yoshida, Shozo; Ogura, Shinji; Seishima, Mariko

doi:10.1111/1744-9987.12210

Cited by 13 publications

(12 citation statements)

References 18 publications

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“…Fujisawa et al reported the efficacy of granulocyte and monocyte adsorption apheresis (GMA) to treat PPP. 15) GMA selectively adsorbs Mac-1-expressing neutrophils and reduces serum levels of proinflammatory cytokines. 15) Although inflammatory cytokines are increased after CPB, 16) there has been no report that an extracorporeal membrane oxygenator removes cytokines.…”

Section: Discussionmentioning

confidence: 99%

Remission of Palmoplantar Pustulosis after On-Pump Coronary Artery Bypass Grafting in a Patient with Titanium Allergy

Kono

Oda

Akaiwa

et al. 2020

ATCS

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Metal allergy is an uncommon but crucial problem during surgery, which can lead to complicated skin diseases, such as palmoplantar pustulosis (PPP). 1) Among metal allergies, titanium allergy is said to be rare. 2) Here, we describe the rare case of a woman with titanium allergy and PPP who underwent coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB) Remission of Palmoplantar Pustulosis after On-Pump Coronary Artery Bypass Grafting in a Patient with Titanium AllergyTakanori Kono, MD, PhD, 1 Takeshi Oda, MD, PhD, 1 Keiichi Akaiwa, MD, PhD, 1 Katsuhiko Nakamura, MD, 1 Kenya Sasaoka, MD, 2 and Hiroyuki Tanaka, MD, PhD 3Metal 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.

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Section: Discussionmentioning

confidence: 99%

Remission of Palmoplantar Pustulosis after On-Pump Coronary Artery Bypass Grafting in a Patient with Titanium Allergy

Kono

Oda

Akaiwa

et al. 2020

ATCS

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“…In PPPP, various modalities have shown success, including anti‐IL‐6 agent tocilizumab, and anti‐IL‐12 and IL‐23 agent, ustekinumab . GMA may also be effective …”

Section: Treatmentmentioning

confidence: 99%

Generalized pustular psoriasis: a review and update on treatment

Hoegler

John

Handler

et al. 2018

Acad Dermatol Venereol

160

193

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Generalized pustular psoriasis (GPP) is a subtype of pustular psoriasis characterized by painful and occasionally disfiguring cutaneous manifestations with sepsis-like systemic symptoms. Affecting any age and race, GPP can occur with other forms of psoriasis or by itself. Stimuli for flares include medications, infections and environmental triggers. The interleukin family and caspase recruitment domain family have been implicated in its pathogenesis. Other forms of pustular psoriasis include impetigo herpetiformis, palmoplantar pustular psoriasis, annular pustular psoriasis and acrodermatitis continua of Hallopeau. Treatment is not well established, but includes the use of retinoids, methotrexate, cyclosporine, corticosteroids, TNF-alpha inhibitors, topical therapy and phototherapy. The use of TNF-alpha inhibitors may result in the formation of antidrug antibodies and should be administered with methotrexate.

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“…In a previous report, 14 patients with localized pustular psoriasis were treated with GMA resulting in two cases with excellent outcomes, seven effective, three relatively effective and two unresponsive . One report demonstrated the efficacy of GMA against PPP skin manifestations in three patients . There is another report on successful treatment against PPP with extra‐palmoplantar lesions and PAO by GMA .…”

Section: Discussionmentioning

confidence: 99%

“…9 One report demonstrated the efficacy of GMA against PPP skin manifestations in three patients. 10 There is another report on successful treatment against PPP with extra-palmoplantar lesions and PAO by GMA. 11 In our study, an improvement of 50% in the PPPASI score was achieved only by one or two patients of the five after GMA, and deterioration was noted in two patients.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the efficacy of granulocyte and monocyte adsorption apheresis on skin manifestation and joint symptoms of patients with pustulotic arthro‐osteitis

Kawakami

Nagaoka

Hirano

et al. 2018

The Journal of Dermatology

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Pustulotic arthro‐osteitis, occasionally complicated with palmoplantar pustulosis, affects patients’ activities of daily living. Granulocyte and monocyte adsorption apheresis selectively removes activated granulocytes and monocytes by means of extracorporeal circulation. Although the efficacy of granulocyte and monocyte adsorption apheresis in the treatment of generalized pustular psoriasis has been proved, very few reports have assessed its efficacy in the treatment of palmoplantar pustulosis and pustulotic arthro‐osteitis. Ten pustulotic arthro‐osteitis patients with five palmoplantar skin manifestations were treated with weekly granulocyte and monocyte adsorption apheresis over 5 weeks. Skin manifestations were assessed using palmoplantar pustulosis area and severity index, and joint symptoms were assessed using a visual analog scale of joint pain, tender joint count, swollen joint count and C‐reactive protein immediately before, after and at the 3‐month follow up of the five granulocyte and monocyte adsorption apheresis sessions. Two out of five patients with skin manifestations achieved more than 50% improvement in their score (remarkably improved). However, in two patients, deterioration was noted, in one of whom the skin manifestations remained unchanged at the 3‐month follow up. In five out of the 10 patients, the joint symptoms were assessed as better than improved at the 3‐month follow up. No deterioration was noted at the 3‐month follow up. In three patients, reduction or cessation of medication for arthralgia was possible. We concluded that granulocyte and monocyte adsorption apheresis is a therapeutic option to consider when pustulotic arthro‐osteitis is recalcitrant to conventional therapy.

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Efficacy of Granulocyte and Monocyte Adsorption Apheresis for Treatment of Palmoplantar Pustulosis

Cited by 13 publications

References 18 publications

Remission of Palmoplantar Pustulosis after On-Pump Coronary Artery Bypass Grafting in a Patient with Titanium Allergy

Remission of Palmoplantar Pustulosis after On-Pump Coronary Artery Bypass Grafting in a Patient with Titanium Allergy

Generalized pustular psoriasis: a review and update on treatment

Evaluation of the efficacy of granulocyte and monocyte adsorption apheresis on skin manifestation and joint symptoms of patients with pustulotic arthro‐osteitis

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