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- Presentation
Management of Palmoplantar Pustulosis: Risk Factors, Regional Differences, and Emerging Treatments
Description
The talk reviewed palmoplantar pustulosis (PPP), a chronic sterile pustular disease of the palms and soles that may occur with or without psoriasis and can be associated with SAPHO syndrome or pustulotic arthro-osteitis. PPP shows important regional differences, with much higher prevalence in Japan than in Western countries, and its clinical pattern and treatment response also differ between East Asian and Western populations. Major risk factors include smoking, female sex, obesity, and thyroid dysfunction. Management remains difficult: topical steroids, PUVA phototherapy, acitretin, and cyclosporine are standard options, but long-term control is often poor. Conventional biologics and apremilast have shown only moderate to limited benefit, with many studies failing to show clear superiority over placebo. Newer data are more encouraging for certain targeted therapies, especially brodalumab, bimekizumab, and some JAK inhibitors such as upadacitinib, while risankizumab and spesolimab were less convincing for PPP. The speaker emphasized that these promising results still need confirmation in larger randomized placebo-controlled trials, particularly in Western populations.
View moreConclusions
- Palmoplantar pustulosis remains a difficult-to-treat condition with few highly effective established therapies.
- Female sex, smoking, obesity, and thyroid dysfunction appear to be the main risk factors for PPP.
- PPP shows meaningful epidemiologic and clinical differences between East Asian, especially Japanese, patients and Western populations.
- Traditional options such as topical steroids, PUVA, acitretin, and cyclosporine remain standard treatments, but overall responses are limited.
- Apremilast and several biologics, including anti-TNF, anti-IL23, and anti-IL17A agents, generally provide only moderate benefit.
- Network and trial data suggest that some agents may outperform placebo, but many treatment effects are modest and not uniformly significant.
- Risankizumab produced only partial benefit in Japanese patients with PPP, with better results over time than early response.
- Brodalumab showed faster and more convincing efficacy than several other biologics in Japanese PPP patients.
- IL-17 pathway targeting may be more relevant in PPP than in generalized pustular psoriasis, but not all IL-36–targeted therapy works for PPP.
- Bimekizumab produced strong and rapid responses in a small severe PPP series, making it one of the most promising emerging options.
- Oral JAK inhibitors, especially upadacitinib, showed encouraging real-world results with acceptable short-term safety.
- Overall, the most promising new therapies need confirmation in larger randomized placebo-controlled trials, particularly in Western populations.
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