Interventions for chronic palmoplantar pustulosis.

Area of Science:

• Dermatology
• Evidence-Based Medicine
• Systematic Review

Background:

• Palmoplantar pustulosis (PPP) is a chronic inflammatory skin condition characterized by sterile pustules on the palms and soles.
• The last comprehensive review predates the widespread use of biological therapies, necessitating an updated assessment of interventions.
• Current treatment strategies require evaluation to induce and maintain remission in patients with PPP.

Purpose of the Study:

• To systematically assess the efficacy and safety of various interventions for chronic palmoplantar pustulosis.
• To evaluate treatments aimed at achieving and sustaining complete remission of PPP symptoms.
• To identify gaps in current research and guide future clinical trials.

Main Methods:

• A systematic search of multiple databases (Cochrane Skin, CENTRAL, MEDLINE, Embase, LILACS) and trial registers was conducted up to March 2019.
• Randomized controlled trials (RCTs) involving participants with palmoplantar pustulosis were included, assessing topical, systemic, combination therapies, or non-pharmacological interventions against placebo or other comparators.
• Key outcomes included participant clearance, disease severity improvement, and adverse events, with standard Cochrane methodological procedures applied.

Main Results:

• Thirty-seven RCTs (1663 participants) were included, with most studies assessing systemic treatments, particularly biologics, retinoids, and phototherapy.
• Low to moderate quality evidence suggests maxacalcitol may improve clearance, while oral alitretinoin shows little effect on severity compared to placebo.
• Secukinumab and guselkumab show potential in reducing disease severity, but evidence regarding clearance and serious adverse events remains uncertain or suggests increased risk for secukinumab.

Conclusions:

• High-quality evidence for many common palmoplantar pustulosis treatments, including corticosteroids and methotrexate, is lacking.
• Maxacalcitol demonstrates potential for short-term clearance with similar adverse effect profiles to placebo, while alitretinoin offers no significant benefit over placebo.
• Further high-quality trials are recommended, utilizing validated scales for disease severity and quality of life, to better evaluate existing and emerging therapies for PPP.