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Case Reports
. 2023 Aug 9:16:5165-5172.
doi: 10.2147/IDR.S421299. eCollection 2023.

Refractory Palmoplantar Pustulosis Successfully Treated with JAK Inhibitor Tofacitinib: A Case Series

Qingqing Xu  1 , Xiaochen Wang  2 , Anbo Yang  3 , Guo Wei  1
Affiliations
Case Reports

Refractory Palmoplantar Pustulosis Successfully Treated with JAK Inhibitor Tofacitinib: A Case Series

Qingqing Xu et al. Infect Drug Resist. .

Abstract

Background: Palmoplantar pustulosis (PPP) is a common chronic and recurrent skin disease of the palms and soles with significant pain, mental distress, and functional disability. PPP is challenging to treat and usually requires prolonged management. Therapy resistance and frequent relapse discourages patients from follow-up. No unified standard and no published therapeutic guidelines have yet been defined on PPP treatment. In general, all therapeutic options known for autoimmune diseases, psoriasis in particular, have been tested in PPP. Tofacitinib, an oral JAK inhibitor, has been approved for the treatment of rheumatoid arthritis and shows promise in the treatment of moderate-to-severe plaque psoriasis. However, no clinical trials or case reports have been conducted to confirm the efficacy of tofacitinib in palmoplantar pustulosis.

Methods: Six in total with 6 PPP patient, aged 42-58 years were recruited according to the inclusion and exclusion criteria. Patient characteristics, including triggering factors, concomitant diseases, and previous therapeutic drugs, were investigated. All patients experienced a lack of response to topical drugs and at least one systemic agent. During treatment, visits were scheduled at the start of treatment and at 2, 4, and 12 weeks, and efficacy was assessed using the PPP ASI and PPP PGA.

Results: Our six patients showed an excellent response to tofacitinib as all patients did achieve at least 50% reduction and half of our patients with more than 80% reduction in PPPASI after 4 weeks treatment; at week 12, 5 (83.3%) patients had 80% reduction in PPPASI with no serious adverse events were reported.

Conclusion: The JAK inhibitor tofacitinib is a promising treatment for refractory palmoplantar pustulosis that requires further clinical observation and research.

Keywords: palmoplantar pustular psoriasis area and severity index; refractory palmoplantar pustulosis; tofacitinib.

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Conflict of interest statement

All authors declare that there are no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Clinical images of patient 1 at 0, 2, 4, and 12 weeks after tofacitinib treatment.
Figure 2
Figure 2
Percent change from baseline in PPP ASI over time in all 6 patients.
See this image and copyright information in PMC

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