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Okubo Y, Kobayashi S, Murakami M, Sano S, Kikuta N, Ouchi Y, Terui T. Efficacy and Safety of Brodalumab, an Anti-interleukin-17 Receptor A Monoclonal Antibody, for Palmoplantar Pustulosis: 16-Week Results of a Randomized Clinical Trial. Am J Clin Dermatol 2024:10.1007/s40257-024-00876-x. [PMID: 38954226 DOI: 10.1007/s40257-024-00876-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP), a refractory skin disease characterized by repeated eruptions of sterile pustules and vesicles on palms and/or soles, involves interleukin-17 pathway activation. Brodalumab, a fully human anti-interleukin-17 receptor A monoclonal antibody, is being investigated for use in PPP treatment. OBJECTIVE The aim was to assess the efficacy and safety of brodalumab in Japanese PPP patients with moderate or severe pustules/vesicles. METHODS A phase 3, randomized, double-blind, placebo-controlled trial was conducted between July 2019 and August 2022, at 41 centers in Japan. Patients aged 18-70 years with a diagnosis of PPP for ≥ 24 weeks, a PPP Area Severity Index (PPPASI) score of ≥ 12, a PPPASI subscore of pustules/vesicles of ≥ 2, and inadequate response to therapy were included. Participants were randomized 1:1 to receive brodalumab 210 mg or placebo, subcutaneously (SC) at baseline, weeks 1 and 2, and every 2 weeks (Q2W) thereafter until week 16. Changes from baseline to week 16 in the PPPASI total score (primary endpoint) and other secondary skin-related endpoints and safety endpoints were assessed. RESULTS Of the 126 randomized patients, 50 of 63 in the brodalumab group and 62 of 63 in the placebo group completed the 16-week period. Reasons for discontinuation were adverse event (n = 6), withdrawal by patient/parent/guardian (n = 3), progressive disease (n = 3), and lost to follow-up (n = 1) in the brodalumab group and Good Clinical Practice deviation (n = 1) in the placebo group. Change from baseline in the PPPASI total score at week 16 was significantly higher (p = 0.0049) with brodalumab (least-squares mean [95% confidence interval {CI}] 13.73 [10.91-16.56]) versus placebo (8.45 [5.76-11.13]; difference [95% CI] 5.29 [1.64-8.94]). At week 16, brodalumab showed a trend of rapid improvement versus placebo for PPPASI-50/75/90 response (≥ 50%/75%/90% improvement from baseline) and Physician's Global Assessment 0/1 score: 54% versus 24.2%, 36.0% versus 8.1%, 16.0% versus 0.0%, and 32.0% versus 9.7%, respectively. Infection was the dominant treatment-emergent adverse event (TEAE); the commonly reported TEAEs were otitis externa (25.4%/1.6%), folliculitis (15.9%/3.2%), nasopharyngitis (14.3%/4.8%), and eczema (14.3%/12.9%) in the brodalumab/placebo groups, respectively. The severity of most TEAEs reported was Grade 1 or 2 and less frequently Grade ≥ 3. CONCLUSIONS Brodalumab SC 210 mg Q2W demonstrated efficacy in Japanese PPP patients. The most common TEAEs were mild infectious events. TRIAL REGISTRATION NCT04061252 (Date of Trial Registration: August 19, 2019).
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Affiliation(s)
- Yukari Okubo
- Department of Dermatology, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Satomi Kobayashi
- Department of Dermatology, Seibo International Catholic Hospital, 2-5-1 Nakaochiai, Shinjuku-ku, Tokyo, 161-8521, Japan
| | - Masamoto Murakami
- Department of Dermatology, Ehime University School of Medicine, 454 Shitsukawa, Toon-shi, Ehime, 791-0295, Japan
| | - Shigetoshi Sano
- Department of Dermatology, Kochi Medical School, Kochi University, 185-1 Okochokohasu, Nankoku-shi, Kochi, 783-8505, Japan
| | - Natsuko Kikuta
- Kyowa Kirin Co., Ltd, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Yoshiumi Ouchi
- Kyowa Kirin Co., Ltd, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan.
| | - Tadashi Terui
- Division of Dermatological Science, Department of Dermatology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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Liu C, Liu X, Xin H, Li X. Associations of inflammatory cytokines with palmoplantar pustulosis: a bidirectional Mendelian randomization study. Front Med (Lausanne) 2024; 11:1387210. [PMID: 38882664 PMCID: PMC11176421 DOI: 10.3389/fmed.2024.1387210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/07/2024] [Indexed: 06/18/2024] Open
Abstract
Background Variations in circulatory cytokine levels have been observed during the onset and course of palmoplantar pustulosis (PPP); however, whether these changes are due to etiological or secondary factors is unclear. To clarify the causal relationship, we conducted a summarized-level bidirectional Mendelian randomization (MR) analysis in this study. Methods A FinnGen biobank genome-wide association study (GWAS) of 212,766 individuals (524 PPP patients and 212,242 controls) provided summary data for PPP, whereas genetic instrumental variables (IVs) linked to circulation cytokine levels were gathered from a GWAS of 14,824 European individuals. The inverse-variance weighted (IVW), weighted median (WME), simple mode, and MR-Egger methods were used to ascertain the changes in PPP pathogenic cytokine taxa. Sensitivity analysis, which included horizontal pleiotropy analysis, was then conducted. The reliability of the results was assessed using the leave-one-out approach and the MR Steiger test, which evaluated the strength of a causal relationship. To evaluate the reverse causality between PPP and circulating cytokine levels, a reverse MR analysis was carried out. Results Our study demonstrated positive associations between C-X-C motif chemokine 6 (CXCL6) and PPP (odds ratio, OR 1.257, 95%CI: 1.001-1.570, p = 0.043). C-C motif chemokine 19 (CCL19) and interleukin-6 (IL-6) were suggested to be protectively associated with the development of PPP (OR: 0.698,95% CI: 0.516-0.944, p = 0.020; OR: 0.656, 95%CI:0.437-0.985, p = 0.042). The results were steady after sensitivity and heterogeneity analyses. Conclusion At the genetic prediction level, we identified causally connected inflammation-related variables that contributed to the onset and development of PPP. The therapeutic options for some refractory PPP have expanded due to tailored cytokine therapy, generating fresh concepts for PPP diagnostics and mechanism investigation.
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Affiliation(s)
- Chengling Liu
- Center of Burns and Plastic Surgery and Dermatology, The 924th Hospital of Joint Logistics Support Force of the PLA, Guilin, China
| | - Xingchen Liu
- Department of Pathology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Haiming Xin
- Center of Burns and Plastic Surgery and Dermatology, The 924th Hospital of Joint Logistics Support Force of the PLA, Guilin, China
| | - Xin Li
- Center of Burns and Plastic Surgery and Dermatology, The 924th Hospital of Joint Logistics Support Force of the PLA, Guilin, China
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Vasudevan B, Das P, Bhatt S. Pustular psoriasis: A distinct aetiopathogenic and clinical entity. Indian J Dermatol Venereol Leprol 2024; 90:19-29. [PMID: 37317717 DOI: 10.25259/ijdvl_542_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 04/12/2023] [Indexed: 06/16/2023]
Abstract
Pustular psoriasis is a distinct subset of psoriasis that presents with involvement of the skin in the form of sterile pustules along with systemic manifestations. Though it has been conventionally grouped under the umbrella of psoriasis, recent research has shed light on its pathogenetic mechanisms associated with the IL-36 pathway, which is distinct from conventional psoriasis. Pustular psoriasis in itself is a heterogeneous entity consisting of various subtypes, including generalised, localised, acute, and chronic forms. There is confusion regarding its current classification as entities like deficiency of IL-36 antagonist (DITRA) which are closely related to pustular psoriasis both in their pathogenetic mechanism and its clinical manifestations, are not included under pustular psoriasis. Entities like palmoplantar pustulosis, which presents with similar clinical features but is pathogenetically distinct from other forms of pustular psoriasis, are included under this condition. Management of pustular psoriasis depends upon its severity; while some of the localised variants can be managed with topical therapy alone, the generalised variants like Von Zumbusch disease and impetigo herpetiformis may need intensive care unit admission and tailor-made treatment protocols. The advent of newer biologics and better insight into the pathogenesis of pustular psoriasis has opened the way for newer therapies, including tumour necrosis factor-alpha inhibitors, interleukin-1 inhibitors, interleukin-17 inhibitors, and granulocyte monocyte apheresis. It continues to be an enigma whether pustular psoriasis is actually a variant of psoriasis or an entirely different disease entity, though we feel that it is an entirely different disease process.
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Affiliation(s)
- Biju Vasudevan
- Department of Dermatology, Armed Forces Medical College (AFMC), Wanowarie, Pune, India
| | - Pankaj Das
- Department of Dermatology, Armed Forces Medical College (AFMC), Wanowarie, Pune, India
| | - Siddharth Bhatt
- Department of Dermatology, Armed Forces Medical College (AFMC), Wanowarie, Pune, India
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Yatsuzuka K, Kawakami R, Niko Y, Tsuda T, Kameda K, Kohri N, Yoshida S, Shiraishi K, Muto J, Mori H, Fujisawa Y, Imamura T, Murakami M. A fluorescence imaging technique suggests that sweat leakage in the epidermis contributes to the pathomechanism of palmoplantar pustulosis. Sci Rep 2024; 14:378. [PMID: 38172327 PMCID: PMC10764317 DOI: 10.1038/s41598-023-50875-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024] Open
Abstract
Sweat is an essential protection system for the body, but its failure can result in pathologic conditions, including several skin diseases, such as palmoplantar pustulosis (PPP). As reduced intraepidermal E-cadherin expression in skin lesions was confirmed in PPP skin lesions, a role for interleukin (IL)-1-rich sweat in PPP has been proposed, and IL-1 has been implicated in the altered E-cadherin expression observed in both cultured keratinocytes and mice epidermis. For further investigation, live imaging of sweat perspiration on a mouse toe-pad under two-photon excitation microscopy was performed using a novel fluorescent dye cocktail (which we named JSAC). Finally, intraepidermal vesicle formation which is the main cause of PPP pathogenesis was successfully induced using our "LASER-snipe" technique with JSAC. "LASER-snipe" is a type of laser ablation technique that uses two-photon absorption of fluorescent material to destroy a few acrosyringium cells at a pinpoint location in three-dimensional space of living tissue to cause eccrine sweat leakage. These observatory techniques and this mouse model may be useful not only in live imaging for physiological phenomena in vivo such as PPP pathomechanism investigation, but also for the field of functional physiological morphology.
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Affiliation(s)
- Kazuki Yatsuzuka
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Ryosuke Kawakami
- Department of Molecular Medicine for Pathogenesis, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yosuke Niko
- Research and Education Faculty, Multidisciplinary Science Cluster, Interdisciplinary Science Unit, Kochi University, Kochi, Japan
| | - Teruko Tsuda
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kenji Kameda
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Nobushige Kohri
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Satoshi Yoshida
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Ken Shiraishi
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Jun Muto
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hideki Mori
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yasuhiro Fujisawa
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Takeshi Imamura
- Department of Molecular Medicine for Pathogenesis, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Masamoto Murakami
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan.
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Fukumoto T, Horita N, Yoshioka A. Recurrent palmoplantar pustulosis at the site of insertion of therapeutic titanium. J Dermatol 2023; 50:e223-e225. [PMID: 36805619 DOI: 10.1111/1346-8138.16750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/22/2023]
Affiliation(s)
- Takeshi Fukumoto
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Hospital, Yokohama, Japan
| | - Ai Yoshioka
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
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Naito Y, Matsumura S, Hada Y, Tanaka M, Takahagi S, Hide M. Pustular eruption on the palms and soles associated with zinc allergy and perspiration. JAAD Case Rep 2023; 36:92-95. [PMID: 37274145 PMCID: PMC10238805 DOI: 10.1016/j.jdcr.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- Yukiko Naito
- Department of Dermatology, Hosokawa-Naito Clinic, Hiroshima, Japan
| | - Shunji Matsumura
- Department of Internal Medicine, Yoshijima Hospital, Hiroshima, Japan
| | | | - Maiko Tanaka
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shunsuke Takahagi
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michihiro Hide
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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Xu JM, Wang HM, Jin HZ. An update on therapeutic options for palmoplantar pustulosis: a narrative review and expert recommendations. Expert Rev Clin Immunol 2023; 19:499-516. [PMID: 36970858 DOI: 10.1080/1744666x.2023.2185775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
INTRODUCTION 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. AREAS COVERED 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. EXPERT OPINION 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.
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Response to the article by Naik et al entitled "anakinra for refractory pustular psoriasis: A phase II, open label, dose-escalation trial". J Am Acad Dermatol 2023; 88:e145-e146. [PMID: 36372378 DOI: 10.1016/j.jaad.2022.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022]
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Sachen KL, Arnold Greving CN, Towne JE. Role of IL-36 cytokines in psoriasis and other inflammatory skin conditions. Cytokine 2022; 156:155897. [DOI: 10.1016/j.cyto.2022.155897] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/29/2022] [Accepted: 04/22/2022] [Indexed: 12/15/2022]
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Involvement of Molecular Mechanisms between T/B Cells and IL-23: From Palmoplantar Pustulosis to Autoimmune Diseases. Int J Mol Sci 2022; 23:ijms23158261. [PMID: 35897837 PMCID: PMC9332852 DOI: 10.3390/ijms23158261] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Palmoplantar pustulosis (PPP) is a disease that causes recurrent blisters and aseptic pustules on the palms and soles. It has been suggested that both innate and acquired immunity are involved. In particular, based on the tonsils and basic experiments, it has been assumed that T and B cells are involved in its pathogenesis. In addition, the results of clinical trials have suggested that IL-23 is closely related to the pathogenesis. This review describes PPP and the genetic background, the factors involved in the onset and exacerbation of disease and its relation to the molecular mechanism. In addition, we describe the usefulness of biological therapy and its implications in relation to the importance in pathology, the pathogenesis of PPP, the importance of the role of the IL-23-Th17 axis and IL-36 in PPP. Furthermore, we describe an animal experimental model of PPP, the efficacy and mechanism of action of guselkumab, an anti-IL-23 antibody, the latest research, and finally the possibility for it to be effective for other autoimmune diseases.
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Kim M, Kim M, Kim JW, Kim BR, Youn SW. Clinical characteristics of pustulotic arthro-osteitis in Korea. J Dermatol 2022; 49:762-768. [PMID: 35510638 DOI: 10.1111/1346-8138.16413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/15/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
Abstract
Pustulotic arthro-osteitis (PAO) has been studied primarily in Japan. However, there is a lack of research regarding its clinical features among large populations in other countries and it is often believed to be similar to psoriatic arthritis (PsA). Although the association between psoriasis (PsO) and palmoplantar pustulosis (PPP) is debatable, differences in the clinical characteristics between PsA and PAO might support the notion that PsO and PPP are distinct entities. This study aimed to investigate the clinical characteristics of PAO in Korean patients and to compare them with those of PsA. We retrospectively reviewed the medical records of patients diagnosed with PPP, PAO, and PsA. Among 266 patients with PPP, 13.2% had PAO. Unlike Japanese patients with PAO, Korean patients had a relatively lower involvement of the chest wall. PAO patients demonstrated lower age of onset, higher proportion of females, and higher severity of cutaneous eruptions compared to PPP patients without PAO, but the differences were not statistically significant. Female predominance was prominent in PAO compared to PsA. Cutaneous eruptions occurred earlier than joint symptoms in 83.5% of the patients with PsA and in 42.9% of the patients with PAO. PAO involved axial joints more frequently compared to PsA, especially the chest wall and spine. PsA mainly involved the peripheral joints, especially the metacarpophalangeal joints and distal interphalangeal joints of the hands and feet. In conclusion, PAO and PsA exhibited different demographics and locations of joint involvement, supporting the notion that PPP and PsO are separate disorders. Many PAO patients presented with joint symptoms before the appearance of skin eruptions, underlining the important role of dermatologists in recognizing PAO among PPP patients. Physicians should be aware of the characteristics of PAO while treating patients with PPP.
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Affiliation(s)
- Minsu Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Minjae Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jee-Woo Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Bo Ri Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
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Ren K, Xia Y. Lipocalin 2 Participates in the Epidermal Differentiation and Inflammatory Processes of Psoriasis. J Inflamm Res 2022; 15:2157-2166. [PMID: 35386225 PMCID: PMC8979418 DOI: 10.2147/jir.s358492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/22/2022] [Indexed: 12/16/2022] Open
Abstract
As a multifunctional cytokine, lipocalin 2 is weakly expressed in skin and serum under normal conditions. However, it is over-expressed by neutrophils and keratinocytes in the skin lesions and sera in several skin diseases. Recent studies demonstrated that lipocalin 2 participates in the pathogenesis of psoriasis by exerting versatile effects on skin resident cells and infiltrating immune cells. Lipocalin 2 inhibits the synthesis of keratin, involucrin, and loricrin in keratinocytes, leading to epidermal parakeratosis via the Tcf7l1-lipocalin 2 signaling axis. It also recruits inflammatory cells such as T cells and neutrophils into skin lesions via the IL-23/IL17, p38-MAPK, and ERK-1/2 signaling pathways. Additionally, lipocalin 2 and other cytokines such as IL-17 have the synergetic effects on skin cells. The neutralization of lipocalin 2 or relevant cytokines can alleviate psoriasis, verifying that lipocalin 2 is an effective interfering target for psoriasis. In this review, we summarize the roles of lipocalin 2 in the processes of psoriatic inflammation and the promising therapeutic strategies based on lipocalin 2-related molecules.
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Affiliation(s)
- Kaixuan Ren
- Department of Dermatology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004, People’s Republic of China
| | - Yumin Xia
- Department of Dermatology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004, People’s Republic of China
- Correspondence: Yumin Xia, Department of Dermatology, The Second Affiliated Hospital of Xi’an Jiaotong University, 157 Xiwu Road, Xi’an, 710004, People’s Republic of China, Tel/Fax +86-29-87679969, Email
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Kim TH, Kim JS, Kwon JE, Park B, Lee ES. Principal Component Analysis to Differentiate Patients with Palmoplantar Pustulosis from Those with Palmoplantar Pustular Psoriasis. Ann Dermatol 2022; 34:7-13. [PMID: 35221589 PMCID: PMC8831310 DOI: 10.5021/ad.2022.34.1.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/12/2022] Open
Abstract
Background Palmoplantar pustulosis (PPP) is initiated from the acrosyringium. However, it is unclear whether PPP should be considered a distinct entity or should be classified into the spectrum of pustular psoriasis, also known as palmoplantar pustular psoriasis (PPPP). Objective We evaluated the differences in immunohistochemical staining in patients with PPP to determine whether they can be classified into two groups based on psoriatic properties or acrosyringeal properties. Methods Nineteen punch biopsy specimens diagnosed with PPP were collected. Antibodies were chosen for identifying the acrosyringeal properties of α-3-nicotine acetylcholine receptors (α-3-nAChR), psoriatic properties of interleukin (IL)-23 and IL-36R, inflammatory cell properties of human cathelicidin antimicrobial peptide 18/LL-37, IL-8, lipocalin-2 (LCN2), and CD3. The degree of staining of the epidermis was evaluated using the ordinal scale (0~3). The principal component analysis was used to derive principal components (PCs) of common variation between the stains, and the two groups were divided using PCs and cluster analysis. Results Three main PCs explained 64% of the total variance in PPP. PC1 (pustular psoriasis properties) showed a higher correlation with IL-36R. PC2 (acrosyringeal/inflammatory properties) showed a higher correlation with α-3-nAChR, IL-8, LCN2, and CD3. PC3 (psoriasis properties) showed a higher correlation with IL-23. PC1 showed a statistically significant difference (p=0.0284) between the two groups. We identified three PCs associated with the pathomechanisms of PPP. Conclusion Although PC1 showed a statistically significant difference between the two groups, we did not identify differential protein expression related to the pathogenesis between PPP and PPPP.
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Affiliation(s)
- Tae Hyung Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Ji Su Kim
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Korea
| | - Ji Eun Kwon
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Bumhee Park
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Korea
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Eun-So Lee
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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Nakanishi T, Kokubu H, Fujimoto N, Tanaka T. Detection rate of pustules in palmoplantar pustulosis with dermoscopy. J Dermatol 2021; 49:299-302. [PMID: 34723401 DOI: 10.1111/1346-8138.16222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
In this study, dermoscopy was applied to determine the site of skin biopsy in cases of palmoplantar pustulosis (PPP) with invisible tiny pustules or vesicles. Fifty-two clinically diagnosed PPP patients (11 men and 41 women) were observed by a dermoscope and underwent skin biopsy. Nineteen patients had visible pustules, whereas 33 had no visible pustules. Pustules were detected by a dermoscope on palmoplantar lesions in 17 of the 33 PPP patients. In contrast, 16 patients showed no presence of pustules or vesicles observed by a dermoscope. In this group, biopsy specimens were taken from scaly lesions. Out of the 16 patients, 10 histologically showed pustules in the epidermis. We finally detected pustules for 46 patients among 52 who were clinically diagnosed with PPP. As a result, we detected pustules in PPP for 19 patients on "inspection", and 36 patients on "inspection and dermoscopy", and 46 patients on "inspection, dermoscopy, and biopsy". Dermoscopy is significantly useful comparing the detection rate (inspection, 0.41; inspection and dermoscopy, 0.78; p = 0.0003; using χ2 -test). In addition, we also should learn from the results that the detection rate goes down to 0.78 without a biopsy. Thus, dermoscopy is certainly a useful tool for invisible pustules and also undetectable pustules to detect pustules in PPP. Moreover, we objectively showed that "inspection, dermoscopy, and biopsy" are the best way to make a PPP diagnosis.
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Affiliation(s)
- Takeshi Nakanishi
- Department of Dermatology, Shiga University of Medical Science, Otsu, Japan
| | - Hiraku Kokubu
- Department of Dermatology, Shiga University of Medical Science, Otsu, Japan
| | - Noriki Fujimoto
- Department of Dermatology, Shiga University of Medical Science, Otsu, Japan
| | - Toshihiro Tanaka
- Department of Dermatology, Shiga University of Medical Science, Otsu, Japan
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15
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Okubo Y, Morishima H, Zheng R, Terui T. Sustained efficacy and safety of guselkumab in patients with palmoplantar pustulosis through 1.5 years in a randomized phase 3 study. J Dermatol 2021; 48:1838-1853. [PMID: 34453358 PMCID: PMC9290648 DOI: 10.1111/1346-8138.16132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022]
Abstract
The safety and efficacy of guselkumab for palmoplantar pustulosis (PPP) have been established through week (W)52; however, no sufficient information is available beyond 1 year. This study was conducted to assess the efficacy and safety of guselkumab through W84, and to explore factors associated with the sustainability of its efficacy in Japanese PPP patients. Patients received guselkumab 100 or 200 mg at W0, W4, W12, and every 8 weeks (q8w) until W60, or placebo at W0, W4, and W12. At W16, patients receiving placebo were re‐randomized to receive guselkumab 100/200 mg at W16, W20, and q8w until W60. Efficacy end‐points included PPP Area and Severity Index (PPPASI), PPP Severity Index (PPSI), Physician’s Global Assessment scores, and patient reported outcomes (PRO) (Dermatology Life Quality Index, EuroQoL‐5 Dimensions, and 36‐item Short Form Health Survey). Post‐hoc comparison of patient characteristics was performed between PPPASI‐75/90 responders and non‐responders at W60, and sustained responders and non‐responders at W84. Safety was evaluated through W84. A total of 45, 43, 21, and 24 patients from the guselkumab 100 mg, guselkumab 200 mg, placebo→guselkumab 100 mg, and placebo→guselkumab 200 mg groups, respectively, completed the study through W84. Overall, the mean improvement in the guselkumab groups from baseline in the PPPASI and PPSI total scores at W84 was ~79% and ~66%, respectively. All PRO improved through W84. The proportion of responders through W60 was higher in patients who had not received prior phototherapy and non‐biologic systemic therapy for PPP. Non‐smokers and patients with no prior non‐biologic systemic treatment tended numerically towards sustained efficacy through W84. The majority of treatment‐emergent adverse events (TEAE) were mild to moderate (~88%) with low incidence of serious TEAE (7.6%). Overall, guselkumab showed sustained efficacy and safety with improvement in the health‐related quality of life through W84 in Japanese PPP patients.
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Affiliation(s)
- Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | | | | | - Tadashi Terui
- Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
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16
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Abstract
Palmoplantar pustulosis (PPP) is a chronic inflammatory condition where crops of sterile pustules with erythematous keratotic lesions causing bleeding and pain appear on the palms and soles. Recently, the European Rare and Severe Expert Network considered PPP as a variant of pustular psoriasis with or without psoriasis vulgaris. The prevalence of PPP varies from 0.050 to 0.12%. PPP occurs more frequently in women and the highest prevalence occurred between the ages of 50 and 69 years. Nail psoriasis seems to be frequent in PPP, ranging from 30 to 76%, and psoriatic arthritis in 8.6 to 26% of PPP patients. Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome and pustulotic arthro-osteitis are considered PPP-associated disorders. PPP has been reported with other co-morbidities such as psychiatric disorders, thyroid-associated disease, altered calcium homeostasis, gluten sensitivity diabetes, obesity, and dyslipidemia, but larger studies are required to prove such associations. Environmental exacerbating factors might contribute to the onset or worsening of PPP such as cigarette smoking, stress, focal infections, metal allergies, and drug intake. Genetic predisposition plays an important role in PPP. In PPP, both the innate and the adaptive immune systems are activated. The acrosyringeal expression of IL-17 has been demonstrated, indicating that the eccrine sweat gland is an active component of the skin barrier and an immune-competent structure. Increased levels of several inflammatory molecules, including IL-8, IL-1α, IL-1β, IL-17A, IL-17C, IL-17D, IL-17F, IL-22, IL-23A, and IL-23 receptor, have been detected in PPP biopsies. Increased serum levels of TNF-α, IL-17, IL-22, and IFN-γ have been detected in patients with PPP in comparison to healthy subjects, suggesting a similar inflammatory pattern to psoriasis vulgaris. Oral and tonsillar infections serve as trigger factors for PPP. Long-term therapy is required for many patients, but high-quality data are limited, contributing to uncertainty about the ideal approach to treatment.
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17
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Yamamoto T. Guselkumab for the Treatment of Palmoplantar Pustulosis: A Japanese Perspective. Clin Pharmacol 2021; 13:135-143. [PMID: 34188558 PMCID: PMC8236264 DOI: 10.2147/cpaa.s266223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/11/2021] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, 960-1295, Japan
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18
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Kobayashi K, Kamekura R, Kato J, Kamiya S, Kamiya T, Takano K, Ichimiya S, Uhara H. Cigarette Smoke Underlies the Pathogenesis of Palmoplantar Pustulosis via an IL-17A-Induced Production of IL-36γ in Tonsillar Epithelial Cells. J Invest Dermatol 2021; 141:1533-1541.e4. [PMID: 33188781 DOI: 10.1016/j.jid.2020.09.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/24/2020] [Accepted: 09/09/2020] [Indexed: 02/08/2023]
Abstract
Palmoplantar pustulosis (PPP) is characterized by sterile pustules on the palms and soles. A strong association between PPP and tobacco smoking has been reported, and it has been speculated that the IL-17A pathway may play an important role in PPP. Recent studies have suggested that IL-36 plays a pivotal role in the pathogenesis of psoriasis and its subtypes. The relationships among IL-36, smoking, and PPP have not been examined. Here, we investigated the relationships among the smoking index, severity of the clinical condition of PPP, and in vitro dynamics of IL-36 in human tonsillar epithelial cells under the condition of exposure to a cigarette smoke extract. The results demonstrated that the Palmoplantar Pustulosis Area and Severity Index was strongly and positively correlated with the smoking index in female patients. Immunohistochemical examinations showed that IL-36γ was highly expressed in tonsillar epithelial cells from patients with PPP but not in those from patients with recurrent tonsillitis without PPP. The in vitro study revealed that IL-17A synergistically induced a release of IL-36γ under cigarette smoke extract exposure. These results suggest that local production of IL-36γ by epithelial cells induced by cigarette smoke exposure plays an important role in the pathogenesis of PPP.
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Affiliation(s)
- Keiju Kobayashi
- Department of Dermatology, School of Medicine, Sapporo Medical University, Sapporo, Japan; Department of Human Immunology, Research Institute for Frontier Medicine, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Ryuta Kamekura
- Department of Human Immunology, Research Institute for Frontier Medicine, School of Medicine, Sapporo Medical University, Sapporo, Japan; Department of Otolaryngology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Junji Kato
- Department of Dermatology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Shiori Kamiya
- Department of Dermatology, School of Medicine, Sapporo Medical University, Sapporo, Japan; Department of Human Immunology, Research Institute for Frontier Medicine, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Takafumi Kamiya
- Department of Dermatology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Kenichi Takano
- Department of Otolaryngology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Shingo Ichimiya
- Department of Human Immunology, Research Institute for Frontier Medicine, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Hisashi Uhara
- Department of Dermatology, School of Medicine, Sapporo Medical University, Sapporo, Japan.
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19
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SnapshotDx Quiz: May 2021. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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20
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Murakami M, Kawakami R, Niko Y, Tsuda T, Yatsuzuka K, Mori H, Imamura T, Sayama K. New fluorescent three-dimensional and deep-imaging technique confirms a direct relationship between the acrosyringium and vesicles/pustules of palmoplantar pustulosis. J Dermatol Sci 2021; 102:130-132. [PMID: 33810900 DOI: 10.1016/j.jdermsci.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Masamoto Murakami
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan.
| | - Ryosuke Kawakami
- Department of Molecular Medicine for Pathogenesis, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yosuke Niko
- Research and Education Faculty, Multidisciplinary Science Cluster, Interdisciplinary Science Unit, Kochi University, Kochi, Japan
| | - Teruko Tsuda
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kazuki Yatsuzuka
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hideki Mori
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Takeshi Imamura
- Department of Molecular Medicine for Pathogenesis, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Koji Sayama
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
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21
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Yamamoto T. Similarity and difference between palmoplantar pustulosis and pustular psoriasis. J Dermatol 2021; 48:750-760. [PMID: 33650702 DOI: 10.1111/1346-8138.15826] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/07/2021] [Indexed: 12/11/2022]
Abstract
Palmoplantar pustulosis is a chronic inflammatory disorder characterized by sterile pustules predominantly involving the palms and soles. Palmoplantar pustulosis has many similar aspects to psoriasis, either plaque and pustular type, namely familial occurrence between palmoplantar pustulosis and psoriasis, the appearance of the Köbner phenomenon, joint involvement, and nail involvement. Pustular psoriasis is classified into generalized and localized types, and there are a number of papers regarding palmoplantar pustulosis as an acral variant of localized pustular psoriasis. Many Japanese dermatologists consider palmoplantar pustulosis to be a distinct entity from pustular psoriasis, and the coexistence of palmoplantar pustulosis and psoriasis is rare. However, outside Japan, palmoplantar pustulosis is often considered to be palmoplantar psoriasis or palmoplantar pustular psoriasis, and extra-palmoplantar lesions are also considered to be psoriasis. The purpose of the current review is to compare the similarities and differences between palmoplantar pustulosis and generalized/localized pustular psoriasis. Japanese patients with palmoplantar pustulosis have a close relationship with focal infection, and the associated bone-joint manifestation exclusively involves the anterior chest wall. Furthermore, pediatric occurrence of palmoplantar pustulosis is extremely rare, and difference of genetic background between palmoplantar pustulosis and psoriasis has also been reported. Treatment of focal infection often results in dramatic effects on both cutaneous lesions and joint pain of palmoplantar pustulosis. Those findings suggest that palmoplantar pustulosis should be separately considered from either palmoplantar psoriasis or palmoplantar pustular psoriasis. The clinicopathological features and therapeutic approach of both diseases are discussed.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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22
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Serizawa N, Okazaki S, Otsuka Y, Koto M, Okabe K, Ito M, Morita T, Hoashi T, Saeki H, Abe N, Mori M, Okubo Y, Yano Y, Mitsui H, Kanda N. Dietary habits in Japanese patients with palmoplantar pustulosis. J Dermatol 2021; 48:366-375. [DOI: 10.1111/1346-8138.15719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/13/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Naotaka Serizawa
- Department of Dermatology Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
- Department of Dermatology Nippon Medical School Bunkyo‐Ku Tokyo Japan
| | - Shizuka Okazaki
- Department of Dermatology Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
| | - Yohei Otsuka
- Department of Dermatology Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
| | - Mototaka Koto
- Department of Dermatology Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
| | - Kyochika Okabe
- Department of Dermatology Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
| | - Michiko Ito
- Department of Dermatology Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
| | - Takashi Morita
- Department of Dermatology Nippon Medical School Bunkyo‐Ku Tokyo Japan
| | - Toshihiko Hoashi
- Department of Dermatology Nippon Medical School Bunkyo‐Ku Tokyo Japan
| | - Hidehisa Saeki
- Department of Dermatology Nippon Medical School Bunkyo‐Ku Tokyo Japan
| | - Namiko Abe
- Department of Dermatology Nippon Medical School Bunkyo‐Ku Tokyo Japan
| | - Miho Mori
- Department of Dermatology Tokyo Medical University Shinjuku‐Ku Tokyo Japan
| | - Yukari Okubo
- Department of Dermatology Tokyo Medical University Shinjuku‐Ku Tokyo Japan
| | - Yumiko Yano
- Department of Dermatology Tokyo Medical University Shinjuku‐Ku Tokyo Japan
| | - Hiroshi Mitsui
- Department of Dermatology Tokyo Teishin Hospital Chiyoda‐Ku Tokyo Japan
| | - Naoko Kanda
- Department of Dermatology Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
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23
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Murakami M, Kawakami R, Niko Y, Tsuda T, Mori H, Yatsuzuka K, Imamura T, Sayama K. High-quality Fluorescence Imaging of the Human Acrosyringium Using a Transparency: Enhancing Technique and an Improved, Fluorescent Solvatochromic Pyrene Probe. Acta Histochem Cytochem 2020; 53:131-138. [PMID: 33437099 PMCID: PMC7785460 DOI: 10.1267/ahc.20-00020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/12/2020] [Indexed: 11/22/2022] Open
Abstract
Two-photon, excitation fluorescent microscopy featuring autofluorescence or immunofluorescence, combined with optical clearance using a transparency-enhancing technique, allows deep imaging of three-dimensional (3D) skin structures. However, it remains difficult to obtain high-quality images of individual cells or 3D structures. We combined a new dye with a transparency-enhancing technology and performed high-quality structural analysis of human epidermal structures, especially the acrosyringium. Human fingertip skin samples were collected, formalin-fixed, embedded in both frozen and paraffin blocks, sliced, stained with propidium iodide, optically cleared using a transparency-enhancing technique, and stained with a new fluorescent, solvatochromic pyrene probe. Microscopy revealed fine skin features and detailed epidermal structures including the stratum corneum (horny layer), keratinocytes, eccrine sweat glands, and peripheral nerves. Three-dimensional reconstruction of an entire acrosyringium was possible in one sample. This new fluorescence microscopy technique yields high-quality epidermal images and will aid in histopathological analyses of skin disorders.
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Affiliation(s)
- Masamoto Murakami
- Department of Dermatology, Ehime University Graduate School of Medicine
| | - Ryosuke Kawakami
- Department of Molecular Medicine for Pathogenesis, Ehime University Graduate School of Medicine
| | - Yosuke Niko
- Research and Education Faculty, Multidisciplinary Science Cluster, Interdisciplinary Science Unit, Kochi University
| | - Teruko Tsuda
- Department of Dermatology, Ehime University Graduate School of Medicine
| | - Hideki Mori
- Department of Dermatology, Ehime University Graduate School of Medicine
| | - Kazuki Yatsuzuka
- Department of Dermatology, Ehime University Graduate School of Medicine
| | - Takeshi Imamura
- Department of Molecular Medicine for Pathogenesis, Ehime University Graduate School of Medicine
| | - Koji Sayama
- Department of Dermatology, Ehime University Graduate School of Medicine
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24
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Freitas E, Rodrigues MA, Torres T. Diagnosis, Screening and Treatment of Patients with Palmoplantar Pustulosis (PPP): A Review of Current Practices and Recommendations. Clin Cosmet Investig Dermatol 2020; 13:561-578. [PMID: 32884319 PMCID: PMC7439281 DOI: 10.2147/ccid.s240607] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022]
Abstract
Palmoplantar pustulosis (PPP) is a rare, chronic, recurrent inflammatory disease that affects the palms and/or the soles with sterile, erupting pustules, which are debilitating and usually resistant to treatment. It has genetic, histopathologic and clinical features that are not present in psoriasis; thus, it can be classified as a variant of psoriasis or as a separate entity. Smoking and upper respiratory infections have been suggested as main triggers of PPP. PPP is a challenging disease to manage, and the treatment approach involves both topical and systemic therapies, as well as phototherapy and targeted molecules. No gold standard therapy has yet been identified, and none of the treatments are curative. In patients with mild disease, control may be achieved with on-demand occlusion of topical agents. In patients with moderate-to-severe PPP, phototherapy or a classical systemic agent (acitretin being the best treatment option, especially in combination with PUVA) may be effective. Refractory patients or those with contraindications to use these therapies may be good candidates for apremilast or biologic therapy, particularly anti-IL-17A and anti-IL-23 agents. Recent PPP trials are focusing on blockage of IL-36 or IL-1 pathways, which play an important role in innate immunity. Indeed, IL-36 isoforms have been strongly implicated in the pathogenesis of psoriasis. Therefore, blockage of the IL-36 pathway has become a new treatment target in PPP, and three studies are currently evaluating the use of monoclonal antibodies that block the IL-36 receptor in PPP: ANB019 and spesolimab (BI 655130). In this review, we explore the diagnosis, screening and treatment of patients with PPP.
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Affiliation(s)
- Egídio Freitas
- Department of Dermatology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | | | - Tiago Torres
- Department of Dermatology, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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25
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Misiak-Galazka M, Zozula J, Rudnicka L. Palmoplantar Pustulosis: Recent Advances in Etiopathogenesis and Emerging Treatments. Am J Clin Dermatol 2020; 21:355-370. [PMID: 32008176 PMCID: PMC7275027 DOI: 10.1007/s40257-020-00503-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Palmoplantar pustulosis (PPP) is a chronic, recurrent skin disease belonging to the spectrum of psoriasis. It is characterized by an eruption of sterile pustules on the palms and soles. Recent studies in PPP have focused on genetic differences between pustular phenotypes and the role of the innate immunological system and the microbiome in the etiopathogenesis of the disease. Mutations in IL36RN (a major predisposing factor for generalized pustular psoriasis) were found in selected patients with PPP and were associated with earlier disease onset. Studies have shown that the interleukin (IL)-17 and IL-36 pathways might be involved in the pathogenesis of PPP. A microbiome has been demonstrated in the vesicopustules of PPP, and an abundance of Staphylococcus appears to be increased by smoking. Improved understanding of the underlying etiopathogenesis of PPP has led to advances in treatment options, and targeted therapies for PPP have been evaluated or are under evaluation against more than 12 molecules in ongoing clinical trials. These targets include CXCR2 (IL-8 receptor type B), granulocyte colony-stimulating factor receptor, IL-1 receptor, IL-8, IL-12, IL-23, IL-17A, IL-17 receptor, IL-36 receptor, phosphodiesterase-4, and tumor necrosis factor-α.
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Affiliation(s)
| | - Joanna Zozula
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland.
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26
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Obermeyer L, Skudlik C, John SM, Brans R. [Occupational aspects of palmoplantar pustulosis : Discussion based on the evaluation of retrospective data]. Hautarzt 2020; 71:699-704. [PMID: 32430542 DOI: 10.1007/s00105-020-04611-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease. Its classification as a variant of psoriasis is controversial. Exogenous factors may affect PPP. OBJECTIVES Occupational aspects of PPP based on a retrospective evaluation of patient data are discussed. METHODS Data from 1518 patients who took part in a tertiary prevention program (TIP) for occupational skin diseases in our department between January 2015 and June 2019 were evaluated. RESULTS PPP was diagnosed in 30 patients (1.98%). The hands were affected in all of them, while concomitant feet involvement was found in 83.3%. The majority was female (70.0%) and reported tobacco smoking (83.3%). Systemic treatment was continued or initiated in one third of patients. In only 8 patients (26.7%) was PPP considered to be work-related. CONCLUSIONS PPP is an endogenous disease which is influenced by nonoccupational factors (e.g., tobacco smoking). Therefore, a thorough investigation is mandatory when assessing whether occupational factors are legally essential and exceed aggravation by everyday life. For this purpose, a well-documented course of the disease and a critical appraisal of occupational and nonoccupational factors are crucial. Only if occupational causality is probable can preventive measures be provided by the statutory accident insurance and PPP can be legally recognized as an occupational disease.
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Affiliation(s)
- L Obermeyer
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.
| | - C Skudlik
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.,Institut für Gesundheitsforschung und Bildung (IGB), Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland
| | - S M John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.,Institut für Gesundheitsforschung und Bildung (IGB), Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland
| | - R Brans
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.,Institut für Gesundheitsforschung und Bildung (IGB), Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland
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27
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Abstract
INTRODUCTION Palmoplantar pustulosis, or pustulosis palmaris et plantaris (PPP), is a chronic, recurrent inflammatory skin disease that is sometimes unresponsive to conventional therapy. The anti-interleukin 23 antibody guselkumab is effective for treating PPP. AREAS COVERED This review details the current understanding of PPP and discusses why guselkumab may be effective. Guselkumab is only approved for the treatment of PPP in Japan. In the United States, Canada, the European Union, and several other countries, it is approved for the treatment of moderate-to-severe plaque psoriasis, but not for PPP. Furthermore, guselkumab was approved only 1 year ago; its efficacy will be proven only by phase 2 and 3 clinical trials. EXPERT OPINION The first double-blinded randomized placebo-controlled trial (RCT) of guselkumab for PPP has been completed. The drug was effective, and guselkumab could be used as a new agent for PPP treatment, in addition to several conventional therapeutics. However, several issues remain. For example, there is no mouse model of PPP, so careful observation of human PPP patients and establishment of a good experimental PPP model are essential.
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Affiliation(s)
- Masamoto Murakami
- Department of Dermatology, Ehime University Graduate School of Medicine , Ehime, Japan
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Murakami M, Terui T. Palmoplantar pustulosis: Current understanding of disease definition and pathomechanism. J Dermatol Sci 2020; 98:13-19. [PMID: 32201085 DOI: 10.1016/j.jdermsci.2020.03.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/08/2020] [Indexed: 12/24/2022]
Abstract
Pustulosis palmaris et plantaris, or palmoplantar pustulosis (PPP), is a chronic pustular dermatitis involving the palms and soles and is characterized by vesicles, pustules, erythema, lichenification, and abnormal desquamation. It is one of the most common skin diseases in Japan but its pathomechanism is unclear and the disease remains poorly defined. Consequently, adequate treatment for PPP is lacking. As a localized type of pustular psoriasis, PPP has long been treated with the conventional therapies used for plaque-type psoriasis, especially in Western countries. However, PPP may be a distinct entity, with a much lower prevalence in Western countries than in Japan. Furthermore, while treatment has yielded insights into the underlying pathology in plaque-type psoriasis, the pathogenesis of PPP has yet to be elucidated. In 2018, Gulselkumab, a monoclonal antibody against interleukin (IL)-23, was certified for use in Japan and is the first biologic effective in PPP both in Japanese and other patients. In this review, we summarize the current understanding of PPP, including the revised definition and possible pathomechanism. The information presented herein provides a more complete picture of PPP and may facilitate the development of improved treatment options.
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Affiliation(s)
- Masamoto Murakami
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan.
| | - Tadashi Terui
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan.
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Obeid G, Do G, Kirby L, Hughes C, Sbidian E, Le Cleach L. Interventions for chronic palmoplantar pustulosis. Cochrane Database Syst Rev 2020; 1:CD011628. [PMID: 31958161 PMCID: PMC6984641 DOI: 10.1002/14651858.cd011628.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Palmoplantar pustulosis is a chronic inflammatory disease in which sterile, relapsing pustules appear on the palms and soles, possibly in conjunction with other symptoms. The previous Cochrane Review on this topic was published in 2006, before biological treatments were extensively used. OBJECTIVES To assess the effects of interventions for chronic palmoplantar pustulosis to induce and maintain complete remission. SEARCH METHODS We searched the following databases up to March 2019: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers and checked the reference lists of the included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA We considered RCTs including people with palmoplantar pustulosis or chronic palmoplantar pustular psoriasis assessing topical therapy, systemic therapy, combinations of topical or systemic therapies, or non-pharmacological therapies compared with placebo, no intervention, or each other. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our outcomes included 'Proportion of participants cleared or almost cleared', 'Proportion of participants with adverse effects serious or severe enough to cause withdrawal', 'Proportion of participants with at least 50% improvement in disease severity', and 'Proportion of participants with adverse effects'. MAIN RESULTS We included 37 studies (1663 participants; mean age 50 years (range 34 to 63); 24% males). These studies reported condition severity differently. Around half of the included trials stated the setting (hospitals, community clinics, or both). More than half of the studies were at high risk of bias in at least one domain. Our included studies assessed mainly systemic treatments (retinoids, ciclosporin, biologics, etretinate + PUVA (combination of psoralens and long-wave ultraviolet radiation) therapy combined, and antibiotics), but also topical treatments (dermocorticoids, vitamin D) and phototherapy (PUVA, ultraviolet A1 (UVA1)). Other interventions were assessed by single studies. The most common comparator was placebo. All results presented in this abstract were assessed in the short term (mean treatment duration was 11 weeks (range 8 to 24 weeks)) and are based on participants with chronic palmoplantar pustulosis. All outcome time point measurements were taken from baseline and assessed at the end of treatment. Short-term and long-term outcomes were defined as measurement up to 24 weeks after randomisation and between 24 and 104 weeks after randomisation, respectively. One trial (188 participants) assessed the topical vitamin D derivative maxacalcitol versus placebo and found that maxacalcitol may be more effective than placebo in achieving clearance (risk ratio (RR) 7.83, 95% confidence interval (CI) 1.85 to 33.12; low-quality evidence), and the risk of adverse effects (such as mild local irritation, pruritus, and haematological or urinary test abnormalities) is probably similar in both groups (RR 0.87, 95% CI 0.64 to 1.19; moderate-quality evidence). Severity was not reported. Two trials (49 participants) assessed PUVA therapy versus placebo or no treatment, providing very low-quality evidence. Adverse effects were reported with oral PUVA (including nausea, ankle swelling, and non-purulent conjunctivitis) and with local PUVA (including blistering, erythema, and pruritus). With regard to the systemic retinoid alitretinoin, one trial (33 participants; moderate-quality evidence) showed that alitretinoin probably makes little or no difference in reducing severity when compared to placebo (RR 0.69, 95% CI 0.36 to 1.30). A similar number of adverse events were reported in both treatment groups, including headache, cheilitis, nausea, arthralgia, and nasopharyngitis (RR 0.84, 95% CI 0.61 to 1.17). Clearance was not reported. There may be little or no difference between etanercept and placebo in achieving clearance (RR 1.64, 95% CI 0.08 to 34.28; 1 study; 15 participants; low-quality evidence); however, the 95% CI was very wide, showing there may be a difference between groups. Severity was not measured. More patients treated with placebo may achieve reduced severity than those treated with ustekinumab, but the wide 95% CI indicates there might be little or no difference between groups and there might be greater effect with ustekinumab (RR 0.48, 95% CI 0.11 to 2.13; 1 study; 33 participants; low-quality evidence). Clearance was not reported. It is uncertain whether guselkumab increases clearance when compared to placebo (2 studies; 154 participants) because the quality of evidence is very low, but guselkumab probably better reduces disease severity (RR 2.88, 95% CI 1.24 to 6.69; 1 study; 49 participants; moderate-quality evidence). Secukinumab is probably superior to placebo in reducing severity (RR 1.55, 95% CI 1.02 to 2.35; 1 study; 157 participants; moderate-quality evidence), but our clearance outcome was not reported. None of these trials reported on occurrence of adverse effects. Only two of the studies discussed above reported adverse effects serious or severe enough to cause withdrawal. Guselkumab may cause more serious adverse events when compared to placebo, but there is uncertainty due to the very wide 95% CI showing there may be little or no difference and showing more events with placebo (RR 2.88, 95% CI 0.32 to 25.80; 1 study; 49 participants; low-quality evidence). Secukinumab probably causes more serious adverse events than placebo (RR 3.29, 95% CI 1.40 to 7.75; 1 study; 157 participants; moderate-quality evidence). AUTHORS' CONCLUSIONS Evidence is lacking for major chronic palmoplantar pustulosis treatments such as superpotent corticosteroids, phototherapy, acitretin, methotrexate, and ciclosporin. Risk of bias and imprecision limit our confidence. Maxacalcitol may be more effective than placebo in achieving clearance in the short term (low-quality evidence), and the risk of adverse effects is probably similar (moderate-quality evidence). Oral alitretinoin is probably no more effective than placebo in reducing severity, with a similar risk of adverse effects (moderate-quality evidence). Regarding biological treatments, we are uncertain of the effect of etanercept on clearance and the effect of ustekinumab on severity (low-quality evidence). Secukinumab and guselkumab are probably superior to placebo in reducing severity (moderate-quality evidence). Adverse events not requiring withdrawal were not reported for these treatments. Reporting of serious adverse effects was incomplete: compared to placebo, secukinumab probably caused more participant withdrawals (moderate-quality evidence), but we are uncertain of the effect of guselkumab (low-quality evidence). Future trials should assess commonly used treatments using validated severity and quality of life scales.
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Affiliation(s)
- Grace Obeid
- Hôpital du Sacré CœurDepartment of DermatologyBeirutLebanon
| | - Giao Do
- Hôpital Henri MondorDepartment of Dermatology51 avenue du Général de Lattre de TassignyCréteilFrance94010
| | - Lisa Kirby
- Queen Elizabeth University Hospital (The Southern General Hospital)Department of Dermatology1345 Govan RoadGlasgowUKG51 4TF
| | - Carolyn Hughes
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Emilie Sbidian
- Hôpital Henri MondorDepartment of Dermatology51 avenue du Général de Lattre de TassignyCréteilFrance94010
- Université Paris Est Créteil (UPEC)Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) ‐ EA 7379CréteilFrance
| | - Laurence Le Cleach
- Hôpital Henri MondorDepartment of Dermatology51 avenue du Général de Lattre de TassignyCréteilFrance94010
- Université Paris Est Créteil (UPEC)Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) ‐ EA 7379CréteilFrance
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Oktem A, Uysal PI, Akdoğan N, Tokmak A, Yalcin B. Clinical characteristics and associations of palmoplantar pustulosis: an observational study. An Bras Dermatol 2019; 95:15-19. [PMID: 31899067 PMCID: PMC7058866 DOI: 10.1016/j.abd.2019.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background Palmoplantar pustulosis is a chronic and relapsing disease of the palms and soles, which is characterized by scattered clusters of pinhead-sized, sterile pustules. Objective The aim of the present study was to determine demographic features, co-morbidities, and relation of palmoplantar pustulosis with psoriasis. Methods A total of 48 patients (M/F: 15/33) were enrolled in the present study. A detailed history regarding age of onset, palmoplantar pustulosis duration, number of recurrences, personal and family history of psoriasis, accompanying arthritis, sternoclavicular tenderness, dental fillings, smoking status, and autoimmune disease was obtained; thorough dermatological examination was carried out. Patch testing results and laboratory investigations for thyroid autoimmunity were recorded. Results Thirty-five of 48 patients (72.9%) were current smokers. Twenty of the 48 patients (41.7%) had dental fillings. There was not any significant correlation between palmoplantar pustulosis duration and dental filling duration (p = 0.170). Psoriasis was not detected in any patients either in history or in dermatological examination. Nail involvement and joint complaints were observed in seven of 48 patients (14%) and in nine of 48 patients (18%), respectively. Autoimmune thyroiditis was observed in four of 48 patients (12%). Patients with patch testing positivity (12.5% of patients, M/F: 1/5) had no considerable association for history of external contact with these materials. Study limitations Retrospective analysis. Conclusion Palmoplantar pustulosis appears to be a distinct entity from psoriasis. Routine thyroid functions test could be analyzed, but patch testing is not required in patients with palmoplantar pustulosis. Also, patients with palmoplantar pustulosis must be evaluated for musculoskeletal symptoms and signs.
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Affiliation(s)
- Ayse Oktem
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
| | - Pınar Incel Uysal
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Neslihan Akdoğan
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Aslı Tokmak
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Basak Yalcin
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Masuda-Kuroki K, Murakami M, Tokunaga N, Kishibe M, Mori H, Utsunomiya R, Tsuda T, Shiraishi K, Tohyama M, Sayama K. The microbiome of the "sterile" pustules in palmoplantar pustulosis. Exp Dermatol 2019; 27:1372-1377. [PMID: 30281856 DOI: 10.1111/exd.13791] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/11/2018] [Accepted: 09/26/2018] [Indexed: 12/13/2022]
Abstract
The skin microbiome influences skin pathophysiology. Palmoplantar pustulosis (PPP) is a chronic skin disease characterized by infectious-like pustules on the palms and soles. These pustules are thought to be sterile because bacterial cultures obtained from the pustules are negative. However, culture methods are limited in their ability to identify all bacteria on the skin. We hypothesized that the "sterile" pustules of PPP do not lack bacteria, but rather contain a microbiome. To test this hypothesis, we identified bacteria in "sterile" pustules using non-culture methods. We conducted Sanger and 16S rRNA sequencing using primers specific to the V1-V2 region in PPP-pustulovesicles (PVs) (n = 43) and pompholyx vesicle fluids (n = 15). Sanger sequencing identified some Staphylococcus, Propionibacterium, Streptococcus and Pyrinomonas species in PPP-PVs but failed to identify any bacteria in most of the pompholyx vesicles. 16S rRNA sequencing of PPP-PVs indicated the presence of a microbiome that included various phyla, including Firmicutes, Proteobacteria, Actinobacteria and Bacteroidetes. At the genus level, smokers had higher levels of Staphylococcus in PPP-PVs compared with non-smokers. These results indicate that a microbiome exists in "sterile" pustules of PPP and that PPP smokers had higher levels of Staphylococcus in pustules. It is therefore necessary to reconsider the pathogenesis of PPP from the perspective of the microbiome.
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Affiliation(s)
- Kana Masuda-Kuroki
- Department of Dermatology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Masamoto Murakami
- Department of Dermatology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Naohito Tokunaga
- Advanced Research Support Center, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Mari Kishibe
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hideki Mori
- Department of Dermatology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Ryo Utsunomiya
- Department of Dermatology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Teruko Tsuda
- Department of Dermatology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Ken Shiraishi
- Department of Dermatology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Mikiko Tohyama
- Department of Dermatology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Koji Sayama
- Department of Dermatology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
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Murakami M, Muto J, Masuda-Kuroki K, Tsuda T, Mori H, Utsunomiya R, Shiraishi K, Sayama K. Pompholyx vesicles contain small clusters of cells with high levels of hyaluronate resembling the pustulovesicles of palmoplantar pustulosis. Br J Dermatol 2019; 181:1325-1327. [PMID: 31254390 DOI: 10.1111/bjd.18261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M Murakami
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - J Muto
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - K Masuda-Kuroki
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - T Tsuda
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - H Mori
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - R Utsunomiya
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - K Shiraishi
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - K Sayama
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
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Matsumoto Y, Harada K, Maeda T, Egusa C, Hirano H, Okubo Y, Tsuboi R. Molecular detection of fungal and bacterial DNA from pustules in patients with palmoplantar pustulosis: special focus on Malassezia species. Clin Exp Dermatol 2019; 45:36-40. [PMID: 31220362 DOI: 10.1111/ced.14026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a distinct, chronic skin disorder characterized by intraepidermal pustules on the palms and soles. It is hypothesized that microorganisms on the skin might induce the symptoms of PPP via inflammatory cell activation. However, the microbiota has not been studied in detail because of the assumption that the pustules in PPP are sterile. AIM To elucidate the role of microorganisms in pathogenesis of PPP. METHODS PCR analysis was performed of microbial DNA fragments in the pustules of patients with PPP. The sequence of the D1/D2 LSU 26s rRNA gene and that of the 16S rRNA gene was used for fungal and bacterial DNA detection, respectively. RESULTS In total, 71 samples were carefully collected from the pustules of patients with PPP. Fungal DNA bands were detected in 68 samples, and fungi including Malassezia spp. were identified in 30 of 71 samples (42.3%). Malassezia restricta was the most frequently encountered fungus (14/71; 19.7%). However, bacterial DNA was not detected by the methods used. Furthermore, identical fungal DNA was not detected in the outer lid of the pustules, suggesting that the fungi detected within the pustule did not derive from contamination via the skin surface. CONCLUSIONS In the present study, we demonstrated for the first time that certain pustules in patients with PPP contain fungal DNA fragments, especially those of Malassezia spp. Our findings provide new insights on the role of skin microbiota in the pathogenesis of PPP.
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Affiliation(s)
- Y Matsumoto
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - K Harada
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - T Maeda
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - C Egusa
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - H Hirano
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Y Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - R Tsuboi
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
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Terui T, Kobayashi S, Okubo Y, Murakami M, Hirose K, Kubo H. Efficacy and Safety of Guselkumab, an Anti-interleukin 23 Monoclonal Antibody, for Palmoplantar Pustulosis: A Randomized Clinical Trial. JAMA Dermatol 2019; 154:309-316. [PMID: 29417135 DOI: 10.1001/jamadermatol.2017.5937] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Importance Palmoplantar pustulosis (PPP) is a recalcitrant skin disease with no biologics currently approved for treatment. The involvement of interleukin 23 (IL-23) and cytokines of the type 17 helper T cell lineage in the pathogenesis of PPP has been recently postulated. Objective To evaluate the efficacy and safety of guselkumab, an anti-IL-23 monoclonal antibody, in Japanese patients with PPP. Design, Setting, and Participants This double-blind, randomized, placebo-controlled, parallel-group, 24-week trial was conducted between May 14, 2013, and September 27, 2014, at 11 centers in Japan. Participants were patients with moderate to severe PPP that did not respond adequately to conventional treatments. Interventions Patients were randomized 1:1 to receive guselkumab, 200 mg, by subcutaneous injection or matching placebo at weeks 0 and 4. Main Outcomes and Measures Changes in total scores of skin-related outcomes from baseline at the end of week 16 (primary clinical cutoff) and through week 24 were measured. Serum biomarker analyses were performed at baseline, week 4, and week 16, and safety was monitored through week 24. Results Of 49 randomized patients (35 [71%] women; median [range] age, 52 [28-77] years), 41 completed the study at week 24. Mean (SD) PPP severity index total scores (primary end point) improved significantly from baseline in guselkumab-treated patients (-3.3 [2.43]) vs placebo (-1.8 [2.09]) (least squares mean difference, -1.5; 95% CI, -2.9 to -0.2; P = .03). At week 16, PPP area and severity index scores (least squares mean difference, -5.65; 95% CI, -9.80 to -1.50; P = .009) and proportion of patients achieving 50% reduction in these scores (difference in proportion, 39.2; 95% CI, 14.0-64.3; P = .009) improved significantly. A numerically higher proportion of patients had a physician's global assessment score of 1 or less in the guselkumab group vs placebo. Improvement in efficacy scores was maintained through week 24 in the guselkumab group. Significant reductions from baseline in serum IL-17A and IL-17F cytokine levels were observed at weeks 4 and 16. Frequency of treatment-emergent adverse events was comparable between the guselkumab group (19 of 25 patients [76%]) and the placebo group (18 of 24 patients [75%]). Frequent adverse effects included nasopharyngitis (14 patients [29%]), headache (3 patients [6%]), contact dermatitis (3 patients [6%]), and injection site erythema (3 patients [6%]). No major safety concerns emerged during the study. Conclusions and Relevance Targeting IL-23 and its associated immune cascade with guselkumab may be a safe and useful therapeutic option for treatment of PPP. Trial Registration clinicaltrials.gov Identifier: NCT01845987.
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Affiliation(s)
- Tadashi Terui
- Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Satomi Kobayashi
- Department of Dermatology, Seibo International Catholic Hospital, Tokyo, Japan
| | - Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Masamoto Murakami
- Department of Dermatology, Ehime University School of Medicine, Ehime, Japan
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Masuda‐Kuroki K, Murakami M, Kishibe M, Kobayashi S, Okubo Y, Yamamoto T, Terui T, Sayama K. Diagnostic histopathological features distinguishing palmoplantar pustulosis from pompholyx. J Dermatol 2019; 46:399-408. [DOI: 10.1111/1346-8138.14850] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Kana Masuda‐Kuroki
- Department of Dermatology Ehime University Graduate School of Medicine Toon Japan
| | - Masamoto Murakami
- Department of Dermatology Ehime University Graduate School of Medicine Toon Japan
| | - Mari Kishibe
- Department of Dermatology Asahikawa Medical University Asahikawa Japan
| | | | - Yukari Okubo
- Department of Dermatology Tokyo Medical University Tokyo Japan
| | | | - Tadashi Terui
- Department of Dermatology Nihon University School of Medicine Tokyo Japan
| | - Koji Sayama
- Department of Dermatology Ehime University Graduate School of Medicine Toon Japan
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Yamamoto T. Clinical Characteristics of Japanese Patients with Palmoplantar Pustulosis. Clin Drug Investig 2019; 39:241-252. [DOI: 10.1007/s40261-018-00745-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Xiaoling Y, Chao W, Wenming W, Feng L, Hongzhong J. Interleukin (IL)-8 and IL-36γ but not IL-36Ra are related to acrosyringia in pustule formation associated with palmoplantar pustulosis. Clin Exp Dermatol 2018; 44:52-57. [PMID: 29896852 DOI: 10.1111/ced.13689] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Y. Xiaoling
- Department of Dermatology; Peking Union Medical College Hospital; Beijing China
| | - W. Chao
- Department of Dermatology; Peking Union Medical College Hospital; Beijing China
| | - W. Wenming
- Department of Dermatology; Peking Union Medical College Hospital; Beijing China
| | - L. Feng
- Department of Dermatology; Peking Union Medical College Hospital; Beijing China
| | - J. Hongzhong
- Department of Dermatology; Peking Union Medical College Hospital; Beijing China
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Wolk K, Frambach Y, Jacobi A, Wilsmann-Theis D, Phillipp S, Witte-Händel E, Wenzel J, Mössner R, Sabat R. Increased levels of lipocalin 2 in palmoplantar pustular psoriasis. J Dermatol Sci 2018; 90:68-74. [PMID: 29395573 DOI: 10.1016/j.jdermsci.2017.12.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/01/2017] [Accepted: 12/19/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Palmoplantar pustular psoriasis (PPP) is a recalcitrant chronic skin disease affecting the palms and soles. OBJECTIVE To identify and characterize pathogenetic players in PPP. METHODS Clinical and anamnestic data as well as skin and blood samples of 60 PPP patients were collected. Healthy participants served as controls. Analysis of patient samples and cultured primary skin cells was performed by ELISA, qRT-PCR, and immunohistochemistry. RESULTS Upon screening of blood mediators in PPP patients, lipocalin 2 (LCN2) emerged as being significantly upregulated compared to healthy participants. LCN2 blood levels were independent of age, sex, or concomitant psoriasis vulgaris. Keratinocytes in PPP skin lesions were important LCN2 producers. In vitro, LCN2 production of these cells was upregulated by IL-1β and further enhanced by IL-17 and TNF-α, while IL-22 had no effect. Accordingly, a positive relationship between blood IL-1β and LCN2 levels was evident in PPP. LCN2 blood levels also showed a positive correlation with PPP pustule score, Dermatology Quality of Life Index and blood levels of the pro-atherogenic molecule resistin. CONCLUSIONS In PPP, increased blood levels of LCN2 indicate an important activity of IL-1β in the epidermis, may contribute to skin neutrophil infiltration, and may point to an increased pro- atherosclerosis risk.
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Affiliation(s)
- Kerstin Wolk
- Psoriasis Research and Treatment Centre, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Berlin-Brandenburg Centre for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Yvonne Frambach
- Department of Dermatology, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Arnd Jacobi
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Dagmar Wilsmann-Theis
- Department of Dermatology and Allergy, University Medical Center, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Sandra Phillipp
- Psoriasis Research and Treatment Centre, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ellen Witte-Händel
- Psoriasis Research and Treatment Centre, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jörg Wenzel
- Department of Dermatology and Allergy, University Medical Center, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Rotraut Mössner
- Department of Dermatology, Georg-August-University Goettingen, Robert-Koch-Straße 40, 37075 Goettingen, Germany
| | - Robert Sabat
- Psoriasis Research and Treatment Centre, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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39
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Fukumoto T, Tsuchiyama S, Fukunaga A, Nishigori C. Hypohidrosis and metal allergy: Trigger factors for unilateral lichen planus. J Dermatol 2017; 44:963-966. [PMID: 28342246 DOI: 10.1111/1346-8138.13836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/10/2017] [Indexed: 11/28/2022]
Abstract
Unilateral lichen planus (LP) is a rare clinical variant of LP. The etiology of unilateral LP has not been clarified, although various causes have been reported because of the characteristic distribution. We focused on the contribution of metal allergy and sweating in the development of unilateral LP in this case. To confirm the presence of metal allergy, patch tests with metal allergens were performed. To investigate the cause of the unilateral distribution in unilateral LP, the function of sweating and sweat leaking in the dermis was assessed by a thermoregulatory sweat test and immunohistochemical staining of dermcidin. The patch tests with SnCl2 , H2 PtCl6 , ZnCl2 and MnCl2 were positive. The thermoregulatory sweat test using the starch-iodine method (Minor test) with sweating provoked by heat stimulation revealed hypohidrosis of the affected area, whereas no skin lesions were observed on the dorsal hand and wrist where sweating was normal. Histopathological examination showed keratin plugging of the acrosyringium and lymphocytic infiltrations in the papillary and subpapillary dermis around the intraepidermal and intradermal eccrine duct in the affected area. The immunohistochemical staining of dermcidin confirmed sweat leakage in the subpapillary dermis in the affected area. The symptoms refractory to the topical steroids were markedly improved after removal of the dental metals. The coexistence of metal allergy and sweat leakage in the hypohidrotic area may be involved in the development of unilateral LP.
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Affiliation(s)
- Takeshi Fukumoto
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinji Tsuchiyama
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi Fukunaga
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Chikako Nishigori
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
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40
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Murakami M, Kameda K, Tsumoto H, Tsuda T, Masuda K, Utsunomiya R, Mori H, Miura Y, Sayama K. TLN-58, an Additional hCAP18 Processing Form, Found in the Lesion Vesicle of Palmoplantar Pustulosis in the Skin. J Invest Dermatol 2016; 137:322-331. [PMID: 27771329 DOI: 10.1016/j.jid.2016.07.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 06/27/2016] [Accepted: 07/20/2016] [Indexed: 10/20/2022]
Abstract
We previously reported that the early vesicle of the palmoplantar pustulosis (PPP) vesicle originated from eccrine sweat in the acrosyringium and that the PPP vesicle contains the antimicrobial peptide human cathelicidin-18/LL-37. The concentration of LL-37 was sufficient to induce the subsequent inflammation in lesions and human keratinocytes, and the PPP vesicles contained additional small fragments of human cathelicidin-18, of approximately 7 kDa, which have not been identified. The aim of the present study was to clarify the additional processed forms found in PPP vesicles and their physiological effects on normal keratinocytes and sweat gland cells. Lesional PPP vesicles were collected from PPP patients, and endogenous human cathelicidin-18/LL-37 was depleted using a LL-37 antibody affinity column. A designed recombinant human cathelicidin-18 peptide was prepared and incubated with the depleted PPP vesicle fluid to confirm the additional processed form. In-gel digestion analysis and protein sequencing confirmed the additional form as TLN-58. TLN-58 up-regulated IL-17C, IL-8, IL-23, IL-1α, and IL-1β mRNA and protein expression in normal human keratinocytes and also showed antibacterial activity against Staphylococcus aureus, Staphylococcus epidermidis, and group A Streptococcus species, similar to LL-37. This additional form could be involved in the continued inflammation in PPP lesions.
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Affiliation(s)
- Masamoto Murakami
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan.
| | - Kenji Kameda
- Advanced Research Support Center, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hiroki Tsumoto
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Teruko Tsuda
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kana Masuda
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Ryo Utsunomiya
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hideki Mori
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yuri Miura
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Koji Sayama
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
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Benjegerdes KE, Hyde K, Kivelevitch D, Mansouri B. Pustular psoriasis: pathophysiology and current treatment perspectives. PSORIASIS (AUCKLAND, N.Z.) 2016; 6:131-144. [PMID: 29387600 PMCID: PMC5683122 DOI: 10.2147/ptt.s98954] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Psoriasis vulgaris is a chronic inflammatory disease that classically affects skin and joints and is associated with numerous comorbidities. There are several clinical subtypes of psoriasis including the uncommon pustular variants, which are subdivided into generalized and localized forms. Generalized forms of pustular psoriasis include acute generalized pustular psoriasis, pustular psoriasis of pregnancy, and infantile and juvenile pustular psoriasis. Localized forms include acrodermatitis continua of Hallopeau and palmoplantar pustular psoriasis. These subtypes vary in their presentations, but all have similar histopathologic characteristics. The immunopathogenesis of each entity remains to be fully elucidated and some debate exists as to whether these inflammatory pustular dermatoses should be classified as entities distinct from psoriasis vulgaris. Due to the rarity of these conditions and the questionable link to the common, plaque-type psoriasis, numerous therapies have shown variable results and most entities remain difficult to treat. With increasing knowledge of the pathogenesis of these variants of pustular psoriasis, the development and use of biologic and other immunomodulatory therapies holds promise for the future of successfully treating pustular variants of psoriasis.
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Affiliation(s)
| | - Kimberly Hyde
- Texas A&M Health Science Center College of Medicine, Round Rock
| | | | - Bobbak Mansouri
- Texas A&M Health Science Center College of Medicine, Temple
- Department of Dermatology, Scott and White Hospital, Texas A&M Health Science Center College of Medicine, Temple, TX, USA
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42
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Misiak-Galazka M, Wolska H, Rudnicka L. What do we know about palmoplantar pustulosis? J Eur Acad Dermatol Venereol 2016; 31:38-44. [PMID: 27521275 DOI: 10.1111/jdv.13846] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 06/10/2016] [Indexed: 11/29/2022]
Abstract
Palmoplantar pustulosis is characterized by a chronic eruption of sterile pustules on palms and soles. The disease affects mainly women in the sixth and seventh decade of life. Some authors consider palmoplantar pustulosis a separate entity, whereas others consider it a condition in the spectrum of psoriasis. Aim of this study was to summarize the most recent data about PPP which aimed at establishing the nosological position of palmoplantar pustulosis. A systematic search of published literature was carried out. General characteristics of patients with PPP in different populations were present. We reviewed histological, immunological and genetic studies, as well as treatment options for PPP. PPP presents with clinical features, which are not present in psoriasis; however, the common coexistence of psoriasis vulgaris and/or positive family history for psoriasis indicates at least a close relationship between PPP and psoriasis. At present, there are not sufficient data to exclude PPP from psoriasis group.
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Affiliation(s)
- M Misiak-Galazka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - H Wolska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - L Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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43
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Raposo I, Torres T. Palmoplantar Psoriasis and Palmoplantar Pustulosis: Current Treatment and Future Prospects. Am J Clin Dermatol 2016; 17:349-58. [PMID: 27113059 DOI: 10.1007/s40257-016-0191-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Palmoplantar psoriasis and palmoplantar pustulosis are chronic skin diseases with a large impact on patient quality of life. They are frequently refractory to treatment, being generally described as a therapeutic challenge. This article aims to review the definitions of palmoplantar psoriasis and palmoplantar pustulosis, highlighting the similarities and differences in terms of epidemiology, clinical presentation, genetics, histopathology, and pathogenesis, as well as treatment options for both entities. Classical management of mild to moderate palmoplantar pustulosis and palmoplantar psoriasis relies on use of potent topical corticosteroids, phototherapy, and/or acitretin. Nevertheless, these drugs have proven to be insufficient in long-term control of extensive disease. Biologic therapy-namely, anti-interleukin-17 agents and phosphodiesterase type 4 inhibitors-has recently shown promising results in the treatment of palmoplantar psoriasis. Knowledge of the pathophysiologic pathways of both entities is of utmost importance and may, in the future, allow development of molecularly targeted therapeutics.
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Affiliation(s)
- Inês Raposo
- Department of Dermatology, Centro Hospitalar do Porto, Edifício das Consultas Externas, Ex-CICAP, Rua D. Manuel II, s/n, 4100, Porto, Portugal
| | - Tiago Torres
- Department of Dermatology, Centro Hospitalar do Porto, Edifício das Consultas Externas, Ex-CICAP, Rua D. Manuel II, s/n, 4100, Porto, Portugal.
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
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Umezawa Y, Nakagawa H, Tamaki K. Phase III clinical study of maxacalcitol ointment in patients with palmoplantar pustulosis: A randomized, double-blind, placebo-controlled trial. J Dermatol 2015; 43:288-93. [PMID: 26282062 DOI: 10.1111/1346-8138.13064] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 07/01/2015] [Indexed: 01/07/2023]
Abstract
Palmoplantar pustulosis (PPP) often shows resistance to treatment. Vitamin D3 analog (VitD3 ) has been widely used for the treatment of psoriasis, however, the efficacy and safety of topical VitD3 treatment of PPP are not fully confirmed. Maxacalcitol topical ointment (22-oxacalcitriol [OCT]) was applied twice daily for 8 weeks. Evaluation of efficacy was based on scored skin findings for three main symptoms (erythema, pustules/vesicles and keratinization/scales). The primary and secondary end-points were the total and symptom-specific scores of skin findings, respectively. A total of 188 patients with moderate or severe PPP were enrolled in the study and were randomized into either the OCT group (n = 95) or placebo group (n = 93). The total scores (mean ± standard error) of skin findings at the last observation adjusting for those on day 1 were 5.0 ± 0.20 in the OCT group and 6.9 ± 0.20 in the placebo group. There was a significant decrease in the total score of skin findings in the OCT group compared with the placebo group (P < 0.0001). In particular, the score of pustules/vesicles drastically decreased in the OCT group. In terms of safety, the incidence of adverse reactions in the OCT and placebo groups were 11.6% and 9.7%, respectively. These results indicate that OCT is effective and highly safe in the management of PPP. Topical OCT treatment was found to show a potent action on pustules/vesicles thereby contributing to the cure of PPP.
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Affiliation(s)
- Yoshinori Umezawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hidemi Nakagawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kunihiko Tamaki
- Department of Dermatology, Division of Sensory and Motor System Medicine, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Obeid G, Do G, Katsahian S, Kirby L, Hughes C, Le Cleach L. Interventions for chronic palmoplantar pustulosis. Hippokratia 2015. [DOI: 10.1002/14651858.cd011628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Grace Obeid
- Hôpital Henri Mondor; Department of Dermatology; 51 Avenue du Maréchal de Lattre de Tassigny Créteil France 94000
| | - Giao Do
- Hôpital Henri Mondor; Department of Dermatology; 51 Avenue du Maréchal de Lattre de Tassigny Créteil France 94000
| | - Sandrine Katsahian
- Université Paris Descartes; Biostatistics, INSERM UMRS872, Equip 22; 15 rue de l’Ecole de médecine Paris France 75006
| | - Lisa Kirby
- Wirral University Teaching Hospital NHS Foundation Trust; General Medicine; Liverpool UK
| | - Carolyn Hughes
- The University of Nottingham; c/o Cochrane Skin Group; A103, King's Meadow Campus Lenton Lane Nottingham UK NG7 2NR
| | - Laurence Le Cleach
- Hôpital Henri Mondor; Department of Dermatology; 51 Avenue du Maréchal de Lattre de Tassigny Créteil France 94000
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Murakami M, Kaneko T, Nakatsuji T, Kameda K, Okazaki H, Dai X, Hanakawa Y, Tohyama M, Ishida-Yamamoto A, Sayama K. Vesicular LL-37 contributes to inflammation of the lesional skin of palmoplantar pustulosis. PLoS One 2014; 9:e110677. [PMID: 25330301 PMCID: PMC4199729 DOI: 10.1371/journal.pone.0110677] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 09/21/2014] [Indexed: 01/25/2023] Open
Abstract
“Pustulosis palmaris et plantaris”, or palmoplantar pustulosis (PPP), is a chronic pustular dermatitis characterized by intraepidermal palmoplantar pustules. Although early stage vesicles (preceding the pustular phase) formed in the acrosyringium contain the antimicrobial peptides cathelicidin (hCAP-18/LL-37) and dermcidin, the details of hCAP-18/LL-37 expression in such vesicles remain unclear. The principal aim of the present study was to clarify the manner of hCAP-18/LL-37 expression in PPP vesicles and to determine whether this material contributed to subsequent inflammation of lesional skin. PPP vesicle fluid (PPP-VF) induced the expression of mRNAs encoding IL-17C, IL-8, IL-1α, and IL-1β in living skin equivalents, but the level of only IL-8 mRNA decreased significantly upon stimulation of PPP vesicle with depletion of endogenous hCAP-18/LL-37 by affinity chromatography (dep-PPP-VF). Semi-quantitative dot-blot analysis revealed higher concentrations of hCAP-18/LL-37 in PPP-VF compared to healthy sweat (2.87±0.93 µM vs. 0.09±0.09 µM). This concentration of hCAP-18/LL-37 in PPP-VF could upregulate expression of IL-17C, IL-8, IL-1α, and IL-1β at both the mRNA and protein levels. Recombinant hCAP-18 was incubated with dep-PPP-VF. Proteinase 3, which converts hCAP-18 to the active form (LL-37), was present in PPP-VF. Histopathological and immunohistochemical examination revealed that early stage vesicles contained many mononuclear cells but no polymorphonuclear cells, and the mononuclear cells were CD68-positive. The epidermis surrounding the vesicle expresses monocyte chemotactic chemokine, CCL2. In conclusion, PPP-VF contains the proteinase required for LL-37 processing and also may directly upregulate IL-8 in lesional keratinocytes, in turn contributing to the subsequent inflammation of PPP lesional skin.
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Affiliation(s)
- Masamoto Murakami
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
- * E-mail:
| | - Takaaki Kaneko
- Department of Dermatology, Asahikawa Medical College, Asahikawa, Japan
| | - Teruaki Nakatsuji
- Division of Dermatology, University of California San Diego, and VA San Diego Healthcare Center, San Diego, California, United States of America
| | - Kenji Kameda
- Integrated Center for Science, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hidenori Okazaki
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Xiuju Dai
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yasushi Hanakawa
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Mikiko Tohyama
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | | | - Koji Sayama
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
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48
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Becher G, Jamieson L, Leman J. Palmoplantar pustulosis - a retrospective review of comorbid conditions. J Eur Acad Dermatol Venereol 2014; 29:1854-6. [DOI: 10.1111/jdv.12545] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G. Becher
- Department of Dermatology; Western Infirmary of Glasgow; Glasgow UK
| | - L. Jamieson
- Department of Dermatology; Western Infirmary of Glasgow; Glasgow UK
| | - J. Leman
- Department of Dermatology; Western Infirmary of Glasgow; Glasgow UK
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Yamamoto T. Pustulotic arthro-osteitis associated with palmoplantar pustulosis. J Dermatol 2013; 40:857-63. [PMID: 24127744 DOI: 10.1111/1346-8138.12272] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 07/31/2013] [Indexed: 01/08/2023]
Abstract
Palmoplantar pustulosis (PPP) is a chronic inflammatory disorder characterized by sterile pustules predominantly involving the palms and soles of middle-aged women. PPP frequently develops or exacerbates following focal infections, such as tonsillitis, odontogenic infection and sinusitis, either with or without arthralgia and/or extra-palmoplantar lesions. Pustulotic arthro-osteitis (PAO) is a joint comorbidity of PPP, most often affecting the anterior chest wall. PAO is sometimes regarded as the same entity as synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome, and may be a subtype or incomplete type of SAPHO syndrome; however, there are several differences. In Japanese patients, PPP with PAO is frequently seen, whereas SAPHO syndrome in the true meaning is rare. A difference of incidence depending on race suggests that different genetic backgrounds may be responsible for susceptibility to these disorders. Bacterial infection, especially Propionibacterium acnes, is suggested to play an important role in the pathogenesis of SAPHO syndrome. P. acnes is responsible for acne, however, bacterium is unassociated with PPP skin lesions which are characterized by sterile pustules. On the other hand, PAO is frequently triggered by focal infection, and treatment of focal infection results in dramatic effects on the release of joint pain. This paper reviews current insights into the clinicopathophysiology of PAO, and discusses its possible mechanisms in comparison with SAPHO syndrome.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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50
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Bissonnette R, Nigen S, Langley R, Lynde C, Tan J, Fuentes-Duculan J, Krueger J. Increased expression of IL-17A and limited involvement of IL-23 in patients with palmo-plantar (PP) pustular psoriasis or PP pustulosis; results from a randomised controlled trial. J Eur Acad Dermatol Venereol 2013; 28:1298-305. [DOI: 10.1111/jdv.12272] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/14/2013] [Indexed: 01/03/2023]
Affiliation(s)
| | - S. Nigen
- Innovaderm Research Inc.; Montreal QC Canada
| | - R.G. Langley
- Division of Dermatology; Dalhousie University; Halifax NS Canada
| | - C.W. Lynde
- Lynderm Research Inc.; Markham ON Canada
| | - J. Tan
- Windsor Clinical Research; Windsor ON Canada
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