Pustular Psoriasis

Carleen Gibbons · Sep 11, 2007

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Any bright suggestions for a client suffering from Pustular Psoriasis for the last 10 years.

50 year old woman, constitutionally fit and well, no medications at present. Has tried all forms of treatment to no avail.

Only manifests itself to both feet, plantar and borders.

Jbwheele · Sep 11, 2007

Gday Mate

Has she tried topical steroids or calcipotriol "Daivionex" cream?? (think thats how its spelt) ? I dont know if its good on pustular type.

Seen a Dermatologist?

Cheers

Joe wheeler

Carleen Gibbons · Sep 11, 2007

Yes Joe, steroids, prednisone, you name it, and the last 6 months homeopathic tx, no old wives tales???
She is part Maori, great skin and looks after herself.

Carleen Gibbons · Sep 11, 2007

Actually I think a bit of stress may be in there, long hours in retail?

Jbwheele · Sep 13, 2007

Have a look for tinea as well (concomitant?) may look similar / get worse with standing all day etc.. cause pussy blisters.

NewsBot · Dec 19, 2007

Treatment of Hand and Foot Psoriasis with Emphasis on Efalizumab.
Kircik L
Skin Therapy Lett. 2007 Nov;12(9):4-7.

Hand and foot psoriasis is a chronic and debilitating disease that manifests as plaque-type or pustular-type lesions. Although the palms and soles represent only 2% of the total body surface area, psoriasis of these regions may lead to physical dysfunctions that can greatly impair dexterity, mobility, and the quality of life of affected individuals. Deregulation of T-lymphocyte-mediated immune response is important in the pathophysiology of psoriasis. Efalizumab (Raptiva(R), Genentech) is an anti-CD11a monoclonal antibody that disrupts the interaction between T cells and antigen-presenting cells, thereby inhibiting various T-cell-mediated immune processes that include activation and trafficking. Recent evidence indicates that efalizumab may be beneficial for patients with hand and foot psoriasis.
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Carleen Gibbons · Dec 20, 2007

Interesting, thanks for that, will look in to efalizumab

NewsBot · Jul 11, 2008

Open label trial of alefacept in palmoplantar pustular psoriasis.
Carr D, Tusa MG, Carroll CL, Pearce DJ, Camacho F, Kaur M, Cook C, Willard J, McCarty A, Fleischer AB Jr, Liu CM, Goffe BS, Feldman SR.
J Dermatolog Treat. 2008;19(2):97-100.

BACKGROUND: Palmoplantar pustular psoriasis (PPP) is difficult to treat. We assessed the effectiveness of alefacept in PPP and the safety of a 30 mg/week dose.

METHODS: Fifteen individuals with PPP were started on 15 mg/week intramuscularly (IM) alefacept. Efficacy was measured by the PPP severity instrument (PSI). Treatment was continued for 16 weeks, and the alefacept dose was increased to 30 mg/week IM at week 9 if the PSI did not decrease by at least 25%. Other outcomes included physician's global assessment (PGA), reported adverse events and CD4+ T-lymphocyte counts. Clinical response was observed for 12 weeks after the last injection.

RESULTS: The severity of PPP improved in both the PSI and the PGA (p<0.0001 and p = 0.0009, respectively). Much of the improvement occurred after 10 weeks of therapy. Nail severity scores improved (p = 0.0003). CD4+ counts decreased, but all remained >250 cells/mm3. There were no severe adverse effects or discontinuations due to adverse events.

Conclusions: Alefacept in doses up to 30 mg/week was well tolerated in patients with PPP and appeared to have some efficacy. The use of concomitant therapy, the lack of a comparator, and the small sample size are limitations of the study.
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Elizabeth Walsh · Jul 13, 2008

Carleen,

I would be interested to hear if the condition resolves and with which treatment.

"steroids, prednisone, you name it, and the last 6 months homeopathic tx"...
Would you mind listing exactly what has been tried, if you get the chance.

Here are two quite opposite suggestions for your patient.

One is to try drinking organic carrot juice, its a healthy option that won't do her any harm anyway.

Also some information from the Total CPD Ltd Core update in Dermatology.

Recently, smoking has been incriminated as being associated with palmoplantar pustulosis.

Retinoids are vitamin A derivatives;only one is currently available, an example being the aromatic retinoid etretinate (Tigason). It is used initally in a dose of up to 1mg/kg per day, and taken with meals, because it is fat soluble. Once control of psoriasis has been achieved, maintenance doses can be as low as 0.25-0.5 mg/kg per day.

Etretinate has a very long half-life and is markedly teratogenic. Women of child-bearing age, therefore, must not be pregnant when starting the drug, nor must they become pregnant for 2 years after stopping it. They must be asked to give written permission to this stipulation. If a patient wishes to become pregnant, even after 2 years without taking etretinate, blood samples should be taken to check for the presence of the drug or its metabolites.

Other side effects of etretinate therapy include hyperlipidaemia, hepatotoxicity,
general dryness and thinning of the skin. Together with some hair loss. Mucoskeletal changes are essentially those of hypervitaminosis A, with occasional arthralgia. Spinal X-Rays need to be taken periodically, looking for calcification in ligaments and vertebral hyperostosis.

Etretinate may be used on its own to treat severe plaque psoriasis or erythrodermic or generalized pustular psoriasis. It may also be effective in combination with PUV A therapy (psoralen and UVA combined).
It is particularily useful for palmoplantar pustulosis.

Conclusion
Psoriasis is a common condition, and in most cases can be treated effectively and simply in the patient's home. Safe and simple topical remedies containing tar or dithranol will suffice to control the disorder in the majority of cases; the more hazardous systemic treatments should be reserved for those few patients whose psoriasis is sufficiently severe to justify the risks involved.
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cornmerchant · Jul 13, 2008

Hi
I have a patient with longstanding pustular psoriasis who has just undergone a series of PUVA therapy with wonderful success.
He is able to return for more treatment if it recurs , and one tiny patch has, but he may actually buy a unit for use at home.

Regards
Cornmerchant

Carleen Gibbons Member

Jbwheele Active Member

Carleen Gibbons Member

Carleen Gibbons Member

Jbwheele Active Member

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Carleen Gibbons Member

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Elizabeth Walsh Active Member

cornmerchant Well-Known Member

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