Treatment Guidance for Palmoplantar Pustulosis 2022.

Area of Science:

• Dermatology
• Immunology
• Rheumatology

Background:

• Palmoplantar pustulosis (PPP) is an inflammatory skin disease with chronic pustular eruptions on palms and soles.
• It affects approximately 140,000 individuals in Japan, with sterile osteitis (pustulotic arthro-osteitis) occurring in 10-30% of patients.
• Focal infections are identified as triggering factors in about 80% of PPP and related osteitis cases.

Purpose of the Study:

• To update the Treatment Guidance for Palmoplantar Pustulosis 2022.
• To clarify diagnostic criteria, including clinical and histopathological findings.
• To outline treatment algorithms and recommendation grades, distinguishing PPP from psoriasis based on pathophysiology and triggers.

Main Methods:

• Expert consensus based on extensive clinical experience in Japan.
• Inclusion of relevant basic research findings.
• Consideration of challenges in conducting rigorous clinical trials for focal infection treatments.

Main Results:

• The guidance clarifies diagnostic features of PPP, including pustules, vesicles, and pustulo-vesicles.
• Treatment algorithms are differentiated from psoriasis, emphasizing the role of focal infection management.
• Recommendations are graded, acknowledging limited evidence for focal infection treatments due to trial difficulties.

Conclusions:

• The updated guidance provides a framework for diagnosing and managing PPP.
• It highlights the critical distinction between PPP and psoriasis, particularly regarding the impact of focal infections.
• Expert consensus guides treatment recommendations in the absence of extensive clinical trial data.