AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

Management of Hand and Foot Psoriasis

Description

The presentation on the management of hand and foot psoriasis highlights the complexity and variations in treatment approaches for different psoriasis subtypes, particularly non-pustular palmoplantar psoriasis (NPPPP) and pustular palmoplantar psoriasis (PPP). The speaker discusses the diagnostic features of each type, emphasizing the challenges they pose to patients' quality of life due to pain and disability. A variety of treatment options are explored, starting with topical therapies like tapinarof and rifampicin, which have shown good efficacy, particularly in NPPPP. The speaker notes that therapies for palmoplantar psoriasis tend to be less effective compared to those for chronic plaque psoriasis, with methotrexate emerging as a strong first-line option, often more efficacious than acitretin. Additionally, biologics, including TNF inhibitors and IL-17 blockers, are discussed, with some therapies showing promise but generally yielding lower efficacy than for plaque psoriasis. The introduction of JAK inhibitors like tofacitinib is noted as particularly effective for palmoplantar psoriasis, demonstrating rapid action. The talk addresses the need for individualized treatment plans based on variations in disease presentation and treatment response, with a strong emphasis on the importance of supportive management and consultations with other healthcare providers. Overall, the speaker encourages optimism among clinicians, highlighting the diverse therapeutic arsenal available to manage what can be a debilitating condition.

View more

Conclusions

  • Hand and foot psoriasis is a challenging condition with multiple subtypes, including non-pustular and pustular variants, each requiring different therapeutic approaches.
  • A minority of patients with palmoplantar psoriasis can experience significant disability and emotional distress despite small body surface area affected.
  • Topical treatments may not be adequate for palmoplantar psoriasis, indicating the need for more aggressive therapy in affected patients.
  • Methotrexate is effective for palmoplantar psoriasis, being a strong first-line systemic therapy for many patients.
  • JAK inhibitors, such as tofacitinib and upadacitinib, show promising results in the treatment of palmoplantar psoriasis, potentially outperforming traditional therapies.
  • Biologic treatments, including TNF-alpha inhibitors and IL-23 inhibitors, provide varying degrees of efficacy in treating palmoplantar psoriasis, with some patients showing positive results.
  • Ustekinumab may particularly benefit patients whose psoriasis is induced by TNF inhibitors.
  • Combination therapies, such as pairing methotrexate with apremilast, can lead to enhanced treatment outcomes and faster results in palmoplantar psoriasis.
  • Frontiers in treatment options include newer therapies such as deucravacitinib and topical JAK inhibitors, though efficacy data remains limited for some agents.
  • Farley E, et al. J Am Acad Dermatol 2009; 60(6):1024-31
  • Bissonnette R, et al. PLoS One. 2016; 11(6) : e0158190
  • Bissonnette R, et al. J Dermatol Sci. 2017; 85: 20-26
  • Callen et al. J Am Acad Dermatol. 2003;49:897
  • Pettey et al. J Am Acad Dermatol. 2003;49:271
  • Weiss et al. J Am Acad Dermatol. 2002;47:512
  • Fretzin S, et al. J Drugs Dermatol. 2006;5:838-846
  • Goldberg, et al. J Cosmet Laser Ther. 2011 Apr;13(2):47-9.
  • Ara S, et al. Dermatol Ther. 2020 Jul;33(4):e13486. Epub 2020 Jun 10.
  • Janagond AB, et al. J Eur Acad Dermatol Venerol 2013 March;27(3):e384-9
  • Marsland AM, et al. Cochrane Database Syst Rev. 2006
  • Reitamo S, et al. Arch Dermatol 1993;129(10):1273-9
  • Bissonnette R et al. J Eur Acad Dermatol Venereol. 2018 Mar;32(3):403-410
  • Kt S, et al. Am J Clin Dermatol. 2021 Mar 12. doi: 10.1007/s40257-021-00596-6. Online ahead of print. PMID: 33712987
  • Hassanandani T, et al. Indian J Dermatol Venereol Leprol 2023 Jan-Mar;89(2):213-220. doi: 10.25259
  • Mrowietz U, et al. J Am Acad Dermatol. 2019 May;80(5):1344-1352
  • Caldarola G, et al. Drugs Context. 2023;12:2023-1-8
  • Okubo Y, et al. EADV 2022, P0454. Sponsored by Kyowa Kirin
  • Ko, J.M, et al. J Dermatolog Treat. 2009;20(2):100-8
  • Chu DH, et al. Arch Dermatol. 2011 Oct;147(10):1228-30
  • Safa, et al. J Clin Rheumatol. 2011 Oct;17(7):385-6