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Heidemeyer K, May Lee M, Cazzaniga S, Yawalkar N, Naldi L. Palmoplantar Pustulosis: A Systematic Review of Risk Factors and Therapies. Psoriasis (Auckl) 2023; 13:33-58. [PMID: 37772169 PMCID: PMC10522454 DOI: 10.2147/ptt.s400402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/16/2023] [Indexed: 09/30/2023]
Abstract
Palmoplantar pustulosis (PPP) is a chronic, relapsing, inflammatory disease that can occur alone or in association with arthritis. There is still controversy about whether it should be separated from psoriasis or classified as pustular psoriasis. Furthermore, drug-induced paradoxical PPP is a special variant of PPP that differs from classic PPP in several ways. Treatment of PPP is still challenging, and there are a number of treatment-resistant cases. This review summarizes the risk factors for the development of PPP and the currently available treatment modalities. Female sex, smokers or ex-smokers, obesity, thyroid dysfunction, and treatment with a tumor necrosis factor (TNF)-α inhibitor have been identified as risk factors for the disease's development, severity, and course. Topical treatments and phototherapy are effective for some patients and are used as a first-line or adjuvant treatment modality. Conventional treatments including retinoids and fumaric acid show good effects and can increase the efficacy of treatment with psoralen + ultraviolet light therapy (PUVA). Ciclosporin is fast acting, but relapse mostly occurs immediately after cessation. TNF-α inhibitors are efficient, and an even better response can be achieved with IL-17 and IL-23 blockers as well as apremilast. The effect of Janus kinase inhibitors seems to be promising according to case reports, but further investigations with larger cohorts are needed.
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Affiliation(s)
- Kristine Heidemeyer
- Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
- Centro Studi GISED, Bergamo, Italy
| | - Marco May Lee
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
- Centro Studi GISED, Bergamo, Italy
| | - Nikhil Yawalkar
- Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Luigi Naldi
- Centro Studi GISED, Bergamo, Italy
- Dermatology Department, S. Bortolo Hospital, Vicenza, Italy
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2
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Piaserico S, Riedl E, Pavlovsky L, Vender RB, Mert C, Tangsirisap N, Haustrup N, Gallo G, Schuster C, Brunner PM. Comparative effectiveness of biologics for patients with moderate-to-severe psoriasis and special area involvement: week 12 results from the observational Psoriasis Study of Health Outcomes (PSoHO). Front Med (Lausanne) 2023; 10:1185523. [PMID: 37457564 PMCID: PMC10339811 DOI: 10.3389/fmed.2023.1185523] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Psoriasis localized at the scalp, face, nails, genitalia, palms, and soles can exacerbate the disease burden. Real-world studies comparing the effectiveness of treatments for these special areas are limited. Methods Psoriasis Study of Health Outcomes (PSoHO) is an international, prospective, non-interventional, study comparing the effectiveness of anti-interleukin (IL)-17A biologics (ixekizumab and secukinumab) compared to other approved biologics and the pairwise comparative effectiveness of ixekizumab relative to five other individual biologics for patients with moderate-to-severe psoriasis. To determine special area involvement, physicians answered binary questions at baseline and week 12. The proportion of patients who achieved special area clearance at week 12 was assessed. Missing outcome data were imputed as non-response. Comparative treatment analyses were conducted using frequentist model averaging. Results Of the 1,978 patients included, 83.4% had at least one special area involved at baseline with the scalp (66.7%) as the most frequently affected part, followed by nails (37.9%), face/neck (36.9%), genitalia (25.6%), and palms and/or soles (22.2%). Patients with scalp, nail, or genital, but not palmoplantar or face/neck psoriasis, had significantly higher odds of achieving clearance at week 12 in the anti-IL-17A cohort compared to the other biologics cohort. Patients with scalp psoriasis had a 10-20% higher response rate and significantly greater odds (1.8-2.3) of achieving clearance at week 12 with ixekizumab compared to included biologics. Conclusion Biologics demonstrate a high level of clearance of special areas at week 12 in a real-world setting. Patients with scalp, nail, or genital involvement have significantly higher odds of clearance at week 12 with anti-IL-17A biologics compared to other biologics.
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Affiliation(s)
- Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Elisabeth Riedl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Lev Pavlovsky
- Department of Dermatology, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronald B. Vender
- Dermatrials Research Inc. and Venderm Consulting, Hamilton, ON, Canada
| | - Can Mert
- HaaPACS GmbH, Schriesheim, Germany
| | | | | | - Gaia Gallo
- Eli Lilly and Company, Indianapolis, IN, United States
| | - Christopher Schuster
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
- Eli Lilly and Company, Indianapolis, IN, United States
| | - Patrick M. Brunner
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Alghubaywi F, AlJasser MI, Alfadhel M, Almohanna HM. Isolated Palmoplantar Lentiginosis. Clin Cosmet Investig Dermatol 2023; 16:1653-1657. [PMID: 37396712 PMCID: PMC10314746 DOI: 10.2147/ccid.s415686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
The distribution of lentigines offers great insight into the multitude of potential-associated genetic or acquired conditions. In this report, we described a unique presentation of lentigines limited to the palms and soles in a healthy individual. Personal and familial history, clinical examination, serological testing, and whole-genome sequencing were all unremarkable. The benign clinical features and absence of associated medical conditions support the likely lentigo simplex with an isolated palmoplantar distribution. To date, no similar distribution has been reported. This case extends the breadth of view into all possible presentations of lentigines.
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Affiliation(s)
- Faisal Alghubaywi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Division of Dermatology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed I AlJasser
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Division of Dermatology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Majid Alfadhel
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Genetics and Precision Medicine Department, King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia
| | - Hind M Almohanna
- Department of Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Ibba L, Gargiulo L, Alfano A, Cascio Ingurgio R, Narcisi A, Costanzo A, Valenti M. Anti-IL-23 and anti-IL-17 drugs for the treatment of non-pustular palmoplantar psoriasis: a real-life retrospective study. J DERMATOL TREAT 2023; 34:2199108. [PMID: 37010456 DOI: 10.1080/09546634.2023.2199108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Palmoplantar psoriasis is a subtype of psoriasis that occurs in 12-26% of patients during the natural history of the disease. Limited data are available regarding the use of biologics in psoriasis with the involvement of palms or soles. We conducted a retrospective study to assess the effectiveness of anti-Interleukin (IL)-23 and anti-IL-17 in palmoplantar psoriasis over 104 weeks. No statistically significant differences were observed between the two subgroups throughout the study period. After 52 weeks, 80.95% of patients treated with anti-IL-23 and 64.86% receiving an anti-IL-17 achieved a ppPGA of 0 or 1. No serious AEs or AEs leading to discontinuation were observed. Our findings support the effectiveness of IL inhibitors in this difficult-to-treat area.
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Affiliation(s)
- Luciano Ibba
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Luigi Gargiulo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Angela Alfano
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Ruggero Cascio Ingurgio
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Antonio Costanzo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Mario Valenti
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Patil S, Borkar M, Pande S, Meshram K, Oke M. Dermoscopic Findings in Clinically Diagnosed Cases of Plantar Warts, Corns, and Calluses: A Cross-Sectional Study. Cureus 2023; 15:e38093. [PMID: 37252501 PMCID: PMC10209916 DOI: 10.7759/cureus.38093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION With the naked eye, it can frequently be challenging to tell a plantar wart from a corn or callus. A non-invasive diagnostic method called dermoscopy allows for the inspection of morphological features that are not apparent to the unaided eye. This study aimed to examine the dermoscopic findings in pared and unpared cases of palmoplantar warts, corns, and calluses. METHODS Seventy patients who had palmoplantar warts, corns, and calluses were included in this study. A predesigned structured format was used to document the dermoscopic findings. RESULT The majority of patients (51.4%) had warts followed by callus (28.6%) and corn (20%). On dermoscopic examination, all unpared and pared cases of warts had homogenous black/red dots. Translucent central core was present in 92.85% unpared and 100% pared lesions of corns. Homogenous opacity was present in 75% unpared and 100% pared cases of callus. There was no association between unpared and pared lesions (p>0.05). CONCLUSION The accuracy of identifying various clinical types of cutaneous warts, calluses, and corns can be improved by dermoscopy without paring.
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Affiliation(s)
- Sanika Patil
- Department of Dermatology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Milind Borkar
- Department of Dermatology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Sushil Pande
- Department of Dermatology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Kirtee Meshram
- Department of Dermatology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Manjiri Oke
- Department of Dermatology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
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Tam J. The case for considering volar skin in a "separate status" for wound healing. Front Med (Lausanne) 2023; 10:1156828. [PMID: 37035315 PMCID: PMC10076700 DOI: 10.3389/fmed.2023.1156828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Foot ulcers, particularly in the diabetic setting, are a major medical and socioeconomic challenge. While the effects of diabetes and its various sequelae have been extensively studied, in the wound field it is commonly assumed that the wound healing process is essentially identical between different skin types, despite the many well-known specializations in palmoplantar skin, most of which are presumed to be evolutionary adaptations for weightbearing. This article will examine how these specializations could alter the wound healing trajectory and contribute to the pathology of foot ulcers.
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Affiliation(s)
- Joshua Tam
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Dermatology, Harvard Medical School, Boston, MA, United States
- *Correspondence: Joshua Tam,
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Muacevic A, Adler JR, Naz Khan K, Memon S, Naveed T, Shah SA, Farooq O, Ali U. Comparison of the Efficacy of Tap Water Iontophoresis Versus Aluminum Chloride Hexahydrate in the Treatment of Palmoplantar Hyperhidrosis. Cureus 2022; 14:e32367. [PMID: 36627989 PMCID: PMC9826940 DOI: 10.7759/cureus.32367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To compare the efficacy of tap water iontophoresis (TWI) versus aluminum chloride (AC) hexahydrate in the treatment of palmoplantar hyperhidrosis. METHODS The study was a randomized control trial performed at the dermatology department of Pakistan Navy Station (PNS) Shifa Hospital, Karachi from March 2022 to September 2022. A total of 70 palmoplantar hyperhidrosis patients were included in the study after getting approval from the ethical committee. Patients were divided into two groups. Group A patients were treated with TWI three times a week for four weeks. Group B patients were treated with a 20% AC topical solution applied at night to the affected areas for four weeks. The Hyperhidrosis Disease Severity Scale (HDSS) score for both groups was calculated at baseline, one, two, three, and four weeks. The final response was labeled at four weeks by comparing mean HDSS reduction in both groups. SPSS version 28 (IBM Corp., Armonk, NY) was used for data analysis. RESULTS Mean HDSS was compared for both groups at the end of the study, which showed a significant reduction in the mean score from 3.40 ± 0.65 to 1.48 ± 0.78 in group A, as compared to a decline in scores in group B from 3.28 ± 0.67 to 2.14 ± 0.94 (p = 0.002). In group A, zero, one, two, and three points HDSS improvement was 2.9%, 25.7%, 48.6%, and 22.9%, respectively. Whereas in group B, it was 34.3%, 22.9%, 34.3%, and 8.6%, respectively (p = 0.001). CONCLUSION As compared to AC topical solution, TWI is an effective, safe, and inexpensive management option for palmoplantar hyperhidrosis. It causes more improvement in HDSS scores and has lesser side effects.
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Al Muqrin AM, Alghamdi AA, AlShaalan ZM. Rapid Response of Palmoplantar Psoriasis to Risankizumab: A Case Report. Clin Cosmet Investig Dermatol 2022; 15:2129-2132. [PMID: 36217411 PMCID: PMC9547619 DOI: 10.2147/ccid.s384990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022]
Abstract
Palmoplantar psoriasis, a clinical variant of plaque psoriasis, has a significant impact by causing deterioration in the social and functional aspects of patients' lives. Numerous therapeutic interventions are available for palmoplantar psoriasis. Although emerging biological agents have had an enormous positive impact on chronic plaque psoriasis, studies assessing their effectiveness in the palmoplantar phenotype are limited in the literature. We therefore present a case report of a patient with a 10-year history of palmoplantar psoriasis, which has significantly impacted her occupational life. She was treated with Risankizumab, showing a significant and rapid improvement in her symptoms. We believe that Risankizumab could be one of the most effective therapeutic interventions in the clinical context where rapid clearance of palmoplantar psoriasis is required.
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Affiliation(s)
- Abdullah Muqrin Al Muqrin
- Dermatology, Prince Mohammed Medical City, Skaka, AlJouf, Saudi Arabia,Correspondence: Abdullah Muqrin Al Muqrin, Dermatology, Prince Mohammed Medical City, Skaka City, 72345, AlJouf, Saudi Arabia, Tel +96654777446, Email
| | | | - Ziad M AlShaalan
- Department of Internal Medicine, College of Medicine, Jouf University, Skakak, AlJouf, Saudi Arabia
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Gao JC, Wu AG, Contento MN, Maher JM, Cline A. Apremilast in the Treatment of Plaque Psoriasis: Differential Use in Psoriasis. Clin Cosmet Investig Dermatol 2022; 15:395-402. [PMID: 35300435 PMCID: PMC8921676 DOI: 10.2147/ccid.s266036] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/03/2022] [Indexed: 12/15/2022]
Abstract
Small molecule medications like apremilast are emerging as promising options for patients with psoriasis and other inflammatory conditions. Apremilast was approved by the Food and Drug Administration in 2014 for the management of both psoriasis and psoriatic arthritis. Apremilast inhibits phosphodiesterase-4, which increases the intracellular levels of cyclic AMP, thereby reducing inflammatory cytokine production. This review aims to discuss the published evidence and evaluate the differential use of apremilast in plaque psoriasis of the body and scalp, nail psoriasis, and palmoplantar psoriasis. In clinical trials, apremilast effectively reduced the severity of different dermatological manifestations of psoriasis and improved patients' quality of life. It has an acceptable safety profile and is generally well-tolerated. Oral medications like apremilast offer an alternative route of administration which can be more convenient and appropriate for some patients. Additionally, pharmacoeconomic analyses of available anti-psoriatic systemic agents favor apremilast as a cost-effective therapeutic option.
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Affiliation(s)
- Jia C Gao
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Albert G Wu
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | | | | | - Abigail Cline
- Department of Dermatology, New York Medical College, New York, NY, USA
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Tsai J, Rostom M, Garza LA. Understanding and Harnessing Epithelial‒Mesenchymal Interactions in the Development of Palmoplantar Identity. J Invest Dermatol 2022; 142:282-4. [PMID: 34366107 DOI: 10.1016/j.jid.2021.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2023]
Abstract
Palmoplantar skin has several unique characteristics such as increased thickness, high resilience, hypopigmentation, and lack of hair follicles. The establishment of palmoplantar identity occurs through keratinocyte‒fibroblast interactions, with keratin 9 expression and Wnt signaling playing key roles. Understanding how palmoplantar features develop may help efforts to reproduce them at both palmoplantar and nonpalmoplantar body sites.
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Gerdes S, Bräu B, Hoffmann M, Korge B, Mortazawi D, Wiemers F, Wegner S, Personke Y, Gomez M, Sticherling M. Real-world effectiveness of guselkumab in patients with psoriasis: Health-related quality of life and efficacy data from the noninterventional, prospective, German multicenter PERSIST trial. J Dermatol 2021; 48:1854-1862. [PMID: 34510527 DOI: 10.1111/1346-8138.16128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/06/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022]
Abstract
Psoriasis is a common, chronic inflammatory skin disorder negatively impacting health-related quality of life (HRQoL). Guselkumab, targeting interleukin-23 (IL-23), is an approved biologic therapy for psoriasis. PERSIST is an ongoing prospective, noninterventional, long-term, German multicenter study evaluating the effect of guselkumab on HRQoL, and its efficacy and safety in patients with moderate-to-severe psoriasis in a real-world setting. The primary endpoint is the proportion of patients with a Dermatology Life Quality Index (DLQI) score ≤ 1 at week 28. Of 303 patients enrolled and treated with guselkumab, mean age and disease duration were 49.7 and 21.0 years, respectively, and 51.2% (n = 155) of patients had received ≥1 prior biologic therapy. Mean baseline DLQI score was 13.7, and mean symptom and sign scores in the Psoriasis Symptoms and Signs Diary (PSSD) were 51.9 and 60.8, respectively. Baseline Psoriasis Area Severity Index (PASI) and body surface area (%) scores were 16.4 and 27.5. Following 28 weeks of guselkumab treatment, the mean DLQI score decreased to 2.8, and 56.8% of patients (n = 150) achieved DLQI ≤ 1. Mean PSSD symptom and sign scores also improved, decreasing to 12.5 and 15.9, respectively. At week 28, PASI 90 response was 55.3%; significant improvement was observed in patients with psoriasis in difficult-to-treat areas. Overall, analyses demonstrated that guselkumab was effective in the real-world setting, as measured by HRQoL and skin improvements, even in patients with a high burden of disease and those who have received multiple biologic therapies. No new safety signals were observed.
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Affiliation(s)
- Sascha Gerdes
- Psoriasis Center Kiel, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Beate Bräu
- Dermatology Practice Dr. Beate Bräu, Giessen, Germany
| | | | | | | | - Franca Wiemers
- Dermatology Practice Dr. Franca Wiemers, Leipzig, Germany
| | | | | | | | - Michael Sticherling
- Department of Dermatology, University Hospital of Erlangen, Deutsches Zentrum für Immuntherapie, Erlangen, Germany
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Tantanasrigul P, Wichaidit M, Kullavanijaya P. Acral pityriasis rosea: A rare variant of pityriasis rosea. Dermatol Reports 2021; 13:9081. [PMID: 34040707 PMCID: PMC8139122 DOI: 10.4081/dr.2021.9081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022] Open
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Kato K, Al-Sobaihi S, Al-Busani H, Nishizawa A, Ohmi M, Yokozeki H, Namiki T. Analysis of sweating by optical coherence tomography in patients with palmoplantar hyperhidrosis. J Dermatol 2020; 48:334-343. [PMID: 33230876 DOI: 10.1111/1346-8138.15694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022]
Abstract
Optical coherence tomography (OCT) is a high-resolution tomographic imaging technique that uses optical interference. OCT has enabled the non-invasive three-dimensional analysis of individual acrosyringia in the stratum corneum in human skin. However, no report on the measurement of sweating by OCT using clinical data from humans has been published to date. Twenty patients with hyperhidrosis and twenty healthy subjects were included in this study. Imaging of acrosyringia in the stratum corneum using OCT and measurement of the sweat rate using the ventilated capsule method were performed simultaneously. The hand grip exercise of the right hand was used as a load to induce sweating, and the left fingertip was measured before and after the exercise load. Five acrosyringia were extracted from each OCT image, and their volumes were calculated. The mean volume of each acrosyringium was divided by the thickness of the stratum corneum to calculate the mean cross-sectional area of the acrosyringium. Furthermore, the number of sweat droplets on the skin surface was measured. The mean cross-sectional area of acrosyringia after the load increased both in patients with hyperhidrosis and in healthy subjects (P < 0.001). The mean cross-sectional area of acrosyringia of patients with hyperhidrosis was larger than that of healthy subjects (P < 0.001). The mean cross-sectional area of acrosyringia and the sweat rate showed a positive correlation before and after the load (r = 0.88 to 0.91). The number of droplets also increased after the load (P < 0.001), and the number of droplets in patients with hyperhidrosis was higher than in healthy subjects (P < 0.001). Our study has shown that acrosyringia in the stratum corneum increase in proportion to the sweat rate. OCT is a rigorous and valuable method that can measure and quantify sweating in the body without being an invasive procedure.
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Affiliation(s)
- Kohei Kato
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Saber Al-Sobaihi
- Department of Global Health Entrepreneurship, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hind Al-Busani
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Aya Nishizawa
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Masato Ohmi
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroo Yokozeki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Takeshi Namiki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
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Çetinarslan T, Türel Ermertcan A, Temiz P. Dermoscopic clues of palmoplantar hyperkeratotic eczema and palmoplantar psoriasis: A prospective, comparative study of 90 patients. J Dermatol 2020; 47:1157-1165. [PMID: 32691449 DOI: 10.1111/1346-8138.15487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/03/2020] [Indexed: 11/30/2022]
Abstract
Diagnosis can be difficult in isolated palmar and plantar lesions in patients with psoriasis and eczema. The purpose of our study is to compare the dermoscopic findings in patients with palmoplantar psoriasis and palmoplantar hyperkeratotic eczema. This prospective, comparative study included 90 patients histopathologically diagnosed with eczema or psoriasis (35 psoriasis and 55 eczema). The age range was 18-75 years. The most common vessel type was dot vessel in psoriasis. Red globular ring vessels were seen in five patients with psoriasis, but not in any with eczema (P = 0.007). The most common vascular distribution pattern was regular in psoriasis (40%). Patchy vascular pattern was significant in eczema. The most common background color was light red in psoriasis (48.6%) (P < 0.001). Brownish-orange globules were observed in 25.7% of patients with eczema and 5.7% in patients with psoriasis (P = 0.02). There is only one study in the published work about dermoscopy of palmoplantar psoriasis and eczema. In our study, yellow crusts, patchy scale distribution, patchy vascular pattern, yellow scale color, dull red background color and brownish-orange globules were significant in patients with palmoplantar eczema. On the other hand, patients with psoriasis had light red background color, regular vascular distribution pattern and white scale color. We observed globule structures with a pale center and dark peripheral rim only in patients with eczema, which was not identified in previous studies. This globule structure may be a new finding in eczema.
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Affiliation(s)
| | - Aylin Türel Ermertcan
- Departments of, Department of, Dermatology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Peyker Temiz
- Department of, Pathology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
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Tavakoli-Ardakani M, Haghighi S, Shokouhi S, Abtahi-Naeini B, Meidani M, Hassanpour R, Saffaei A. Cytarabine and Doxorubicin-Induced Palmoplantar Erythrodysesthesia Syndrome: The Possible Role of Voriconazole Interaction. Eurasian J Med 2019; 51:313-315. [PMID: 31692616 DOI: 10.5152/eurasianjmed.2019.18459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Palmoplantar Erythrodysesthesia Syndrome (PPES) caused by chemotherapeutic agents is rarely life threatening and requires a reduction in dose or discontinuation of chemotherapy. The use of cytarabine and doxorubicin in the treatment of acute myeloid leukemia (AML) along with voriconazole can potentially alter the metabolism of the drugs and cause some interactions. In this study, we presented a case of AML who received cytarabine and doxorubicin as a chemotherapy regimen and voriconazole as a prophylactic anti-fungal. In this combination, voriconazole probably inhibits the P-glycoprotein pump, which leads to an increase in the cytarabine concentration. The emphasis of this report is the awareness of clinicians and pharmacotherapists about these interactions.
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Affiliation(s)
- Maria Tavakoli-Ardakani
- Department of Clinical Pharmacy, School of Pharmacy and Pharmaceutical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shirin Haghighi
- Department of Hematology and Oncology, Ayatollah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shervin Shokouhi
- Department of Infectious Diseases & Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Abtahi-Naeini
- Skin diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Meidani
- Department of Infectious Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rezvan Hassanpour
- Department of Clinical Pharmacy, School of Pharmacy and Pharmaceutical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Saffaei
- Student Research Committee, Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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17
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Truong A, Le S, Kiuru M, Maverakis E. Nummular dermatitis on guselkumab for palmoplantar psoriasis. Dermatol Ther 2019; 32:e12954. [PMID: 31070862 DOI: 10.1111/dth.12954] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 11/27/2022]
Abstract
A 40-year-old man with chronic history of refractory palmoplantar psoriasis presented with new onset of well-demarcated oval erythematous asteatotic plaques on bilateral shins after starting guselkumab therapy. Histopathology revealed chronic spongiotic dermatitis consistent with a diagnosis of nummular dermatitis. This case highlights a previously unreported adverse event to guselkumab therapy.
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Affiliation(s)
- Allison Truong
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Stephanie Le
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California
| | - Maija Kiuru
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California
| | - Emanual Maverakis
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California
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18
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Bari O, Skillman S, Lah MD, Haggstrom AN. Compound heterozygous mutations in desmoplakin associated with skin fragility, follicular hyperkeratosis, alopecia, and nail dystrophy. Pediatr Dermatol 2018; 35:e218-e220. [PMID: 29633331 DOI: 10.1111/pde.13498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Desmoplakin mutations are associated with a wide variety of phenotypes affecting the skin, nails, hair, and heart. A 21-month-old boy was born with multiple erosions resembling epidermolysis bullosa, complete alopecia, nail dystrophy, palmoplantar keratoderma, and areas of follicular hyperkeratosis. He was found to have two heterozygous mutations in the desmoplakin gene: c.478 C>T in exon 4 (p.Arg160X) and c.3630T>A in exon 23 (Tyr1210X). This case expands the clinical spectrum associated with desmoplakin mutations and highlights a mutation in exon 23 that has not been previously reported in the literature.
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Affiliation(s)
- Omar Bari
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Sarah Skillman
- Department of Dermatology, MetroDerm P.C., Atlanta, GE, USA
| | - Melissa D Lah
- Department of Medical and Molecular Genetics, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Anita N Haggstrom
- Department of Dermatology, School of Medicine, Indiana University, Indianapolis, IN, USA
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Kivelevitch D, Frieder J, Watson I, Paek SY, Menter MA. Pharmacotherapeutic approaches for treating psoriasis in difficult-to-treat areas. Expert Opin Pharmacother 2018; 19:561-575. [PMID: 29565192 DOI: 10.1080/14656566.2018.1448788] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Despite great therapeutic advancements in psoriasis, four notable difficult-to-treat areas including the scalp, nails, intertriginous (including genitals), and palmoplantar regions, pose a challenge to both physicians and patients. Localized disease of these specific body regions inflicts a significant burden on patients' quality of life and requires an adequate selection of treatments. AREAS COVERED This manuscript discusses appropriate therapies and important treatment considerations for these difficult-to-treat areas based on the available clinical data from the literature. EXPERT OPINION Clinical trials assessing therapies for the difficult-to-treat areas have been inadequate. With the first biological clinical trial for genital psoriasis pending publication, it is with hope that other biological agents will be evaluated for region-specific psoriasis. A greater understanding of the genetic and immunologic aspects of regional psoriasis, as well as identification of unique biomarkers, will further guide management decisions. For example, the recent discovery of the IL-36 receptor gene for generalized pustular psoriasis may prove valuable for other forms of psoriasis. Ultimately, identification of the most beneficial treatments for each psoriasis subtype and difficult-to-treat area will provide patients with maximal quality of life.
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Affiliation(s)
- Dario Kivelevitch
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
| | - Jillian Frieder
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
| | - Ian Watson
- b Texas A&M Health Sciences Center College of Medicine , Bryan , TX , USA
| | - So Yeon Paek
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA.,b Texas A&M Health Sciences Center College of Medicine , Bryan , TX , USA
| | - M Alan Menter
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
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Abstract
Introduction: Palmoplantar lesions of lichen planus (LP) are uncommon and may not always have classical clinical features of LP. A variety of morphological types has been described in literature. Aim and Objectives: The aim was to study and classify the clinical variants into distinct easily recognisable categories for quick recognition and early treatment initiation. Methods: All patients diagnosed with LP over a period of 5 years were evaluated for palmoplantar lesions in our hospital. The clinical and histopathological features of the palmoplantar lesions were then studied. Results: Out of 424 patients of LP, 55 (12.9%) had palmoplantar lesions. Histopathology was consistent or at least compatible with LP in 44/55 patients. For the purpose of assessment, only patients with histopathology consistent with LP were included (n = 44) in the study. Just over half of the patients were male, with most patients (43.2%) having had LP lesions elsewhere for 6 months before palmoplantar lesions were noticed. Soles were more frequently involved than palms. The sites most often involved were the centre of the palms (45.2%), and the instep of the soles (63.9%). The predominant morphological presentation was psoriasiform (47.7%). One patient had ulcerative lesions of LP on both his soles which is a very rare variant. Notably, nearly half of the patients (20/44) had mucosal (mostly oral) lesions characteristic of LP. This was significant as typical oral lesions of LP help in identifying palmoplantar lesions that do not have classical lichenoid morphology. Conclusion: LP lesions on palms and soles need to be identified keeping a high index of suspicion and differentiated from other papulosquamous conditions so that specific treatment can be initiated early.
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Affiliation(s)
- Surabhi Sinha
- Department of Dermatology, STD and Leprosy, Dr. Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
| | - Rashmi Sarkar
- Department of Dermatology, STD and Leprosy, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Vijay Kumar Garg
- Department of Dermatology, STD and Leprosy, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Merola JF, Qureshi A, Husni ME. Underdiagnosed and undertreated psoriasis: Nuances of treating psoriasis affecting the scalp, face, intertriginous areas, genitals, hands, feet, and nails. Dermatol Ther 2018; 31:e12589. [PMID: 29512290 PMCID: PMC6901032 DOI: 10.1111/dth.12589] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/01/2017] [Accepted: 12/14/2017] [Indexed: 12/11/2022]
Abstract
Psoriasis of the scalp, face, intertriginous areas, genitals, hands, feet, and nails is often underdiagnosed, and disease management can be challenging. Despite the small surface area commonly affected by psoriasis in these locations, patients have disproportionate levels of physical impairment and emotional distress. Limitations in current disease severity indices do not fully capture the impact of disease on a patient's quality of life, and, combined with limitations in current therapies, many patients do not receive proper or adequate care. In this review, we discuss the clinical manifestations of psoriasis in these less commonly diagnosed areas and its impact on patient quality of life. We also examine clinical studies evaluating the effectiveness of therapies on psoriasis in these regions. This article highlights the need to individualize treatment strategies for psoriasis based on the area of the body that is affected and the emerging role of biologic therapy in this regard.
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Affiliation(s)
- Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Abrar Qureshi
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - M Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
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Gianfaldoni S, Tchernev G, Wollina U, Lotti T. Pustular Palmoplantar Psoriasis Successfully Treated with Nb-UVB Monochromatic Excimer Light: A Case-Report. Open Access Maced J Med Sci 2017; 5:462-466. [PMID: 28785333 PMCID: PMC5535658 DOI: 10.3889/oamjms.2017.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 04/05/2017] [Accepted: 05/21/2017] [Indexed: 11/11/2022] Open
Abstract
Barber’s palmoplantar pustulosis (PPP) is a form of localised pustular psoriasis, affecting the palmar and plantar surfaces. It is a chronic disease, with a deep impact on the patients’ quality of life. The Authors discuss a case of Baber Psoriasis successfully treated with monochromatic excimer light.
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Affiliation(s)
- Serena Gianfaldoni
- University G. Marconi of Rome, Dermatology and Venereology, Rome 00192, Italy
| | - Georgi Tchernev
- Medical Institute of the Ministry of Interior, Dermatology, Venereology and Dermatologic Surgery; Onkoderma, Private Clinic for Dermatologic Surgery, Dermatology and Surgery, Sofia 1606, Bulgaria
| | - Uwe Wollina
- Krankenhaus Dresden-Friedrichstadt, Department of Dermatology and Venereology, Dresden, Sachsen, Germany
| | - Torello Lotti
- Universitario di Ruolo, Dipartimento di Scienze Dermatologiche, Università degli Studi di Firenze, Facoltà di Medicina e Chirurgia, Dermatology, Via Vittoria Colonna 11, Rome 00186, Italy
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23
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Affiliation(s)
- Nicola A Quatrano
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Maressa C Criscito
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Alisa N Femia
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Nooshin K Brinster
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
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24
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Qian G, Wang H, Wu J, Meng Z, Xiao C. Different dermoscopic patterns of palmoplantar and nonpalmoplantar lichen nitidus. J Am Acad Dermatol 2015; 73:e101-3. [PMID: 26282806 DOI: 10.1016/j.jaad.2015.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/03/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Ge Qian
- Department of Dermatology, Zhengzhou Children's Hospital, Zhengzhou, China; Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Heng Wang
- Department of Dermatology, Taihe Hospital of Hubei University of Medicine, Shiyan, China; Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jianbo Wu
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Zudong Meng
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chuncai Xiao
- Department of Dermatology, Zhengzhou Central Hospital affiliated with Zhengzhou University, Zhengzhou, China; Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Liu LS, McNiff JM, Colegio OR. Palmoplantar peeling secondary to sirolimus therapy. Am J Transplant 2014; 14:221-5. [PMID: 24224736 PMCID: PMC4148300 DOI: 10.1111/ajt.12511] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/26/2013] [Accepted: 09/10/2013] [Indexed: 01/25/2023]
Abstract
Sirolimus (rapamycin) is an immunosuppressive agent commonly used in transplant recipients. Although sirolimus has less renal toxicity than calcineurin inhibitors, its use has been limited by its side effects. The most common cutaneous pathologies associated with sirolimus are inflammatory acneiform eruptions, lymphedema and aphthous ulcers. We present a novel cutaneous manifestation of sirolimus therapy that limited its use in at least one transplant recipient. Upon commencing sirolimus therapy, four solid organ transplant recipients developed tender, nonpruritic palmoplantar peeling within the first month of therapy. The peeling clinically resembled a mild form of hand-foot syndrome, yet none of the patients had been treated with chemotherapeutics. Desquamation presented on the palms and soles with dry vesicles and minor peeling extending to the dorsal aspects of the hands and feet. Histologically, the lesions were noninflammatory; the epidermis showed subtle separation between keratinocytes, suggesting either spongiosis or a defect in intercellular adhesion. One patient opted to discontinue treatment because of the tenderness associated with the palmoplantar peeling, which resulted in complete resolution within 2 weeks.
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Affiliation(s)
- L. S. Liu
- Yale Transplant Dermatology Clinic, Yale University School of Medicine, New Haven, CT
| | - J. M. McNiff
- Department of Dermatology, Yale University School of Medicine, New Haven, CT
| | - O. R. Colegio
- Yale Transplant Dermatology Clinic, Yale University School of Medicine, New Haven, CT,Yale-New Haven Transplantation Center, Yale University School of Medicine, New Haven, CT,Corresponding author: Oscar R. Colegio,
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Abstract
Lichen planus (LP) is a common idiopathic inflammatory disorder that affects the flexor aspect of the wrists, the legs, and the oral and genital mucosa. Depending upon the site of involvement, LP can be divided into mucosal, nail, scalp, or palmoplantar types. Palmoplantar LP can pose a diagnostic problem to the clinician as it resembles common dermatoses like psoriasis, verruca, corn, calluses, lichenoid drug eruption, and papular syphilide of secondary syphilis. In this case report, we describe a 4-year-old male child who presented with highly pruritic erythematous to violaceous hyperkeratotic papules and plaques on his palms and soles. Typical LP papules were noted on the upper back. Histopathology of the papular lesion showed features of LP. Dermatoscopy of a papule from the back showed the characteristic Wickham striae. We report this rare involvement of palm and soles in a case of childhood LP.
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Affiliation(s)
- Bhushan Madke
- Department of Dermatology, Seth GS Medical College and KEM hospital, Parel, Mumbai, India
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Nischal KC, Sowmya CS, Swaroop MR, Agrawal DP, Basavaraj HB, Sathyanarayana BD. A novel modification of the autoimplantation therapy for the treatment of multiple, recurrent and palmoplantar warts. J Cutan Aesthet Surg 2012; 5:26-9. [PMID: 22557852 PMCID: PMC3339124 DOI: 10.4103/0974-2077.94332] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Ideal treatment for warts should be effective, safe, have less morbidity and provide long-lasting immunity against human papilloma virus. This can optimally achieved by the stimulation of the immune system against the virus. The autoimplantation of warts, autowart injection and quadrivalent vaccines have been used for this purpose. Autoimplanatation is a simple technique where the subcutis deep wart tissue is harvested as a donor and implanted into the uninvolved skin. However, this led to two wounds, at donor and recipient sites. Aim: The aim was to evaluate the safety and efficacy of a novel modification of autoimplantation therapy in the treatment of multiple, recurrent and palmoplantar warts. Subjects and Methods: Thirty-three patients with multiple, recurrent and palmoplantar warts were enrolled. Instead of taking a bit of the wart tissue, the donor tissue was harvested by paring the wart. The pared tissue was implanted deep into the subcutis by stab incision done using the same surgical blade no. 11. The resolution of all warts within 3 months after the procedure was considered successful. Patients with complete clearance were followed up for 1 month for any recurrence. Results: Out of 35 patients, 27 patients were available for follow-up. A total of 20 (74.1%) patients showed a complete clearance of warts within 3 months. Partial clearance was seen in 1 patient. Erythematous nodules developed at the site of implantation in 3 (11.1%) patients. There was relapse in one patient. Conclusion: A modified technique of autoimplantation of warts employing the pared stratum corneum tissue from the wart is a simple, effective, less traumatic and rapid procedure in the treatment of multiple, recurrent and palmoplantar warts.
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Affiliation(s)
- K C Nischal
- Department of Dermatology, Adichunchanagiri Institute of Medical Sciences, BG Nagar, Mandya, Karnataka, India.
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