There is limited evidence on therapies for palmoplantar pustular psoriasis (PPPP) and maintaining long-term remission. Sevrain et al (J Eur Acad Dermatol Venereol. 2014;28[suppl 5]:13-16) conducted a systematic literature search to identify trials in patients with PPPP that assessed therapeutic interventions (not including systemic biotherapy). They found that oral retinoid therapy (acitretin), photochemotherapy, or a combination of both; low-dose cyclosporine; or topical corticosteroids under occlusion appeared to help relieve symptoms of PPPP. Newer studies have noted the benefits of psoralen plus UVA, with better efficacy compared to UVB therapy. A 308-nm excimer laser has been shown to improve PPPP.
Practice Point: Although phototherapy, cyclosporine, and topical corticosteroids seem to be able to control PPPP, more randomized controlled trials are needed to better define treatment strategies for PPPP.
>>Read more at Journal of the European Academy of Dermatology and Venereology
Treatment of pediatric pustular psoriasis is challenging. Posso-De Los Rios and colleagues (Pediatr Dermatol. 2014;31:430-439) conducted a systematic review of systemic interventions for pediatric pustular psoriasis with a focus on clinical response and treatment outcomes. The most common therapies used for generalized pustular psoriasis were acitretin, cyclosporine, and methotrexate.
Practice Point: Acitretin, methotrexate, and cyclosporine seem to control generalized pustular psoriasis in the pediatric population; however, long-term data are lacking and physicians may encounter disease regression after discontinuing or tapering the medications.
>>Read more at Pediatric Dermatology
Levin et al (J Drugs Dermatol. 2014;13:342-354) sought to evaluate the efficacy and safety of biologics in the treatment of erythrodermic and generalized pustular psoriasis by reviewing the literature. In both psoriasis subtypes, infliximab was used to treat more than half of the reported cases. Other biologics that were successfully used included etanercept, ustekinumab, adalimumab, and anakinra.
Practice Point: Patients with erythrodermic or generalized pustular psoriasis may experience disease improvement with biologics.
>>Read more at Journal of Drugs in Dermatology
