Yamamoto Toshiyuki
Department of Dermatology, Fukushima Medical University, Fukushima, 960-1295, Japan.
Clin Pharmacol. 2021 Jun 23;13:135-143. doi: 10.2147/CPAA.S266223. eCollection 2021.
Palmoplantar pustulosis (PPP) is a chronic inflammatory disorder characterized by sterile pustules predominantly involving the palms and soles. PPP is refractory to various therapies such as topical ointment, oral medicine, and phototherapies. Pustulotic arthro-osteitis (PAO) is a major comorbidity of PPP that severely impairs patients' quality of life. Recently, guselkumab, a monoclonal antibody against IL-23, has been available for the treatment of PPP in Japan. The purpose of the present review is to describe the characteristics of Japanese PPP patients and biologic therapy of PPP/PAO using guselkumab. Most Japanese dermatologists consider PPP as a distinct entity and co-existence of PPP and psoriasis is rare. However, outside Japan, PPP is often considered to be palmoplantar psoriasis, and extra-palmoplantar lesions associated with PPP are regarded as psoriasis. PPP develops or exacerbates either with or without arthralgia, following focal infections, such as tonsillitis, odontogenic infection, and sinusitis. Treatment of focal infection results in dramatic effects on cutaneous lesions as well as joint pain. By contrast, we sometimes see patients whose skin/joint symptoms do not improve after treatment of focal infection, whose focus of infection cannot be identified even in a detailed examination, and/or who refuse tonsillectomy even if strongly recommended. Such cases are considered to be indications of biologics. In this review, clinical features, pathophysiology and guselkumab therapy are discussed.
掌跖脓疱病（PPP）是一种慢性炎症性疾病，其特征为无菌性脓疱，主要累及手掌和足底。PPP对各种治疗方法（如外用软膏、口服药物和光疗）均具有难治性。脓疱性关节骨炎（PAO）是PPP的一种主要合并症，严重损害患者的生活质量。最近，古塞库单抗，一种抗白细胞介素-23的单克隆抗体，在日本已可用于治疗PPP。本综述的目的是描述日本PPP患者的特征以及使用古塞库单抗对PPP/PAO进行生物治疗的情况。大多数日本皮肤科医生认为PPP是一种独特的疾病，PPP与银屑病并存的情况很少见。然而，在日本以外的地区，PPP常被认为是掌跖部银屑病，与PPP相关的掌跖以外的皮损被视为银屑病。PPP在有或无关节痛的情况下，在局部感染（如扁桃体炎、牙源性感染和鼻窦炎）后发生或加重。治疗局部感染对皮肤损害和关节疼痛均有显著效果。相比之下，我们有时会看到一些患者，其皮肤/关节症状在治疗局部感染后并未改善，即使经过详细检查也无法确定感染病灶，和/或即使被强烈建议也拒绝扁桃体切除术。这些病例被认为是生物制剂治疗的适应证。在本综述中，将讨论其临床特征、病理生理学及古塞库单抗治疗。
