Palmoplantar Pustulosis during Pregnancy Was Successfully Treated with Tofacitinib: A Case Report

Palmoplantar pustulosis (PPP) is a common chronic recurrent skin disease characterized by sterile pustules on the palms and soles of the feet. Most patients with PPP have a rash that improves during pregnancy due to the influence of estrogen and progesterone, but relatively few have an exacerbation of the rash during pregnancy.

Here, we show a female patient diagnosed with PPP, whose rash worsened during pregnancy and gestation. Her lesions were painful and cracked, interfering with normal walking and sleep, and was poorly treated with hormonal ointments and ultraviolet light. She gave birth to a healthy baby boy at 39 weeks plus 4 days of gestation after regular monitoring and stopped breastfeeding at 6 months of age and then presented to the outpatient clinic. For sterile pustules, we choose tofacitinib at a dosage of 5 mg b.i.d. Three months after taking the medication, the pustules on her hands and feet had mostly disappeared. Follow-up showed that the condition remained stable without recurrence.

Aggravation of PPP during pregnancy is relatively rare. Tofacitinib, as an oral JAK inhibitor, is effective in the treatment of PPP exacerbated during pregnancy, but the risk to mother and child is unknown, and the relationship between tofacitinib and pregnancy outcome should be further investigated.