Eight-Patient Case Series of Palmoplantar Pustulosis Treated Successfully With Apremilast

Abstract

Background: Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease characterized by sterile pustules, erythema, and scaling on the palms or soles of the feet. Apremilast is a systemic agent that inhibits phosphodiesterase 4 and is approved for the treatment of plaque psoriasis and psoriatic arthritis. Objective: To demonstrate the safety and efficacy of apremilast use in a small patient population with PPP. Methods: A retrospective review of medical charts between September 2008 and October 2017 identified 8 patients diagnosed with PPP and treated with apremilast; relevant literature was also reviewed. Results: The patient population was primarily female (3:1 female to male ratio), had comorbidities, and ranged in age from 39 to 66 years. Traditional PPP therapies were first attempted with limited or failure of response. All 8 patients responded to apremilast and currently remain on apremilast therapy ranging from 4 to 30 months of duration. Apremilast was effective either as monotherapy or in combination with ustekinumab or methotrexate. Minimal side effects were noted. Conclusions: This retrospective review demonstrates the potential for apremilast as a suitable systemic treatment option for PPP when conventional therapies fail or are contraindicated. Other studies have found similar results. Additional case series with larger patient populations or formal clinical trials would provide more definitive conclusions on the usefulness of apremilast in PPP.