Leflunomide in the Treatment of Palmoplantar Pustulosis

Abstract

Palmoplantar pustulosis (PPP) is a chronic inflammatory disease characterized by recurrent pustules on the palms and soles. Its etiology is unknown, and its relationship to psoriasis is not clear. Treatment of PPP can be challenging. Several immunomodulatory drugs have been used with moderate results. Herein, we report 2 cases of PPP that achieved complete remission with leflunomide.

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“…2 Patients suffer from a significant amount of pain in the palms and soles, have impaired dexterity of the hands, difficulty walking, and an inability to work. [2][3][4] Many patients with palmoplantar psoriasis do not have extensive psoriasis on other body parts, therefore the total body surface area (BSA) affected by psoriasis is often lower than 10%, excluding them from most psoriasis clinical trials. Because of its profound impact on quality of life, even greater than in moderate-tosevere psoriasis, 5 and regardless of there often being a low BSA affected, the National Psoriasis Foundation considers palmoplantar psoriasis to be a severe form of psoriasis.…”

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“…Other biologic treatments were reported as efficient: Case reports described the successful treatment of pustular PPP with basiliximab (44), a chimeric monoclonal antibody against the alpha chain of the interleukin‐2 receptor (CD25), and Leflunomide, an immunomodulatory drug inhibiting dihydroorotate dehydrogenase, in the treatment of palmoplantar pustulosis (45). A large group of 11 PPP patients treated with the recently market withdrawn biologic, efalizumab, showed a 50–100% response after 2 weeks to 12 months (46).…”