Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, China.
Expert Rev Clin Immunol. 2023 May;19(5):499-516. doi: 10.1080/1744666X.2023.2185775. Epub 2023 Mar 27.
Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease belonging to the localized form of pustular psoriasis. It is characterized by sterile pustule formation in palms and soles and a recurrent disease course. Although we have many treatments for PPP, there is no authoritative guidance.
A thorough search of PubMed was conducted to identify studies in PPP from 1973 onwards, with additional references to specific articles. Any treatment methods were outcomes of interest, including topical treatment, systemic treatment, biologics, other targeted treatments, phototherapy, and tonsillectomy.
Topical corticosteroids are suggested as first-line therapy. Oral acitretin has become the most applied systemic retinoid recommended in PPP without joint involvement. For patients with arthritis, immunosuppressants like cyclosporin A and methotrexate are more recommended. UVA1, NB-UVB, and 308-nm excimer laser are effective phototherapy options. The combinations of topical or systemic agents and phototherapy may enhance the efficacy, particularly in recalcitrant cases. Secukinumab, ustekinumab, and apremilast are the most investigated targeted therapies. However, heterogeneous reported outcomes in clinical trials provided low-to-moderate quality evidence of their efficacy. Future studies are required to address these evidence gaps. We suggest managing PPP based on the acute phase, maintenance phase, and comorbidities.
掌跖脓疱病（PPP）是一种慢性炎症性皮肤病，属于脓疱型银屑病的局限性形式。其特征为手掌和足底无菌脓疱形成和反复发作。尽管我们有许多 PPP 的治疗方法，但没有权威的指导。
全面检索了 1973 年以来 PubMed 中关于 PPP 的研究，并对特定文章进行了额外引用。任何治疗方法都是关注的结果，包括局部治疗、全身治疗、生物制剂、其他靶向治疗、光疗和扁桃体切除术。
局部皮质类固醇被推荐为一线治疗。口服阿维 A 已成为 PPP 无关节受累时最常应用的推荐系统性维 A 酸。对于关节炎患者，更推荐环孢素 A 和甲氨蝶呤等免疫抑制剂。UVA1、NB-UVB 和 308nm 准分子激光是有效的光疗选择。局部或全身药物联合光疗可能会提高疗效，尤其是在难治性病例中。司库奇尤单抗、乌司奴单抗和阿普米司特是研究最多的靶向治疗药物。然而，临床试验中报告的结果存在异质性，为其疗效提供了低到中等质量的证据。需要进一步的研究来解决这些证据差距。我们建议根据急性期、维持期和合并症来管理 PPP。
