Treatment of Palmoplantar Pustulosis with the Combination of Ustekinumab and Apremilast: A Case Report

Mayba, Julia; Gooderham, Melinda

doi:10.19104/crcm.2016.128

Cited by 3 publications

(3 citation statements)

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“…23 Case reports have suggested that ustekinumab may be effective for some patients with PPP. 10,11,24 A case series of 5 patients demonstrated benefit of ustekinumab in patients with severe refractory palmoplantar pustular psoriasis (PPPP). 10 It was reported that patients responded positively after the initial dose of 45 mg administered subcutaneously, and after 20 weeks, the PPPP in all patients was completely or almost completely resolved.…”

Section: Discussionmentioning

confidence: 99%

“…10 However, we reported a case of PPP where ustekinumab provided only 6 months of PPP improvement before the patient stopped responding. 11 We then added apremilast to ustekinumab, which lead to fast stabilization and resolution of PPP. 23 Gerdes et al presented 4 cases of PPP treated with ustekinumab, with only 2 patients reporting a partial benefit on this therapy.…”

Section: Discussionmentioning

confidence: 99%

“…6 A growing body of literature supports the use of apremilast for PPP. This case series describes the use of apremilast for the treatment of 8 patients with PPP, one of which has been reported previously, 11 and reviews relevant literature.…”

Section: Introductionmentioning

confidence: 99%

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Eight-Patient Case Series of Palmoplantar Pustulosis Treated Successfully With Apremilast

Mikhailitchenko

Crowley

Gooderham

2018

Journal of Psoriasis and Psoriatic Arthritis

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Background: Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease characterized by sterile pustules, erythema, and scaling on the palms or soles of the feet. Apremilast is a systemic agent that inhibits phosphodiesterase 4 and is approved for the treatment of plaque psoriasis and psoriatic arthritis. Objective: To demonstrate the safety and efficacy of apremilast use in a small patient population with PPP. Methods: A retrospective review of medical charts between September 2008 and October 2017 identified 8 patients diagnosed with PPP and treated with apremilast; relevant literature was also reviewed. Results: The patient population was primarily female (3:1 female to male ratio), had comorbidities, and ranged in age from 39 to 66 years. Traditional PPP therapies were first attempted with limited or failure of response. All 8 patients responded to apremilast and currently remain on apremilast therapy ranging from 4 to 30 months of duration. Apremilast was effective either as monotherapy or in combination with ustekinumab or methotrexate. Minimal side effects were noted. Conclusions: This retrospective review demonstrates the potential for apremilast as a suitable systemic treatment option for PPP when conventional therapies fail or are contraindicated. Other studies have found similar results. Additional case series with larger patient populations or formal clinical trials would provide more definitive conclusions on the usefulness of apremilast in PPP.

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