5PSQ-018 Adalimumab in palmoplantar pustulosis

Background and importancePalmoplantar pustulosis (PPP) is a chronic disorder marked by the appearance of recurrent eruptions of fluid filled pustules or blisters on the hands and feet. Its aetiology is unknown and its relationship with psoriasis continues to be controversial. No standardised guidelines are available for treatment. Firstline therapeutic options for PPP include topical corticosteroids, an oral retinoid and photochemotherapy. Patients who do not respond sufficiently to firstline treatment may benefit from combination therapy with an oral retinoid and PUVA or from immunosuppressive therapy. In severe recalcitrant disease, there is some evidence that biologic antitumour necrosis factor drugs can be effective in treating PPP, but this evidence is based on open label trials and non-randomised studies and, therefore, actual efficacy is unknown.Aim and objectivesOur aim was to review the safety and efficacy of the biologic medication, adalimumab, in the treatment of PPP in a patient without response to specific treatments.Material and methodsAn observational retrospective study was conducted in a 69-year-old woman who presented with a 9 year history of recurrent and painful eruptions of pustules on her palms and the soles of her feet. Prior treatment with triamcinolone cream, oral methotrexate and oral acitretin had not improved her skin lesions. She started adalimumab 40 mg per week×2 doses, followed by 40 mg every other week in our hospital over 15 months (2017–2018). Valuable data were collected from review of the medical history and dispensation registers. Clinical features were assessed using scales which measured the number of lesions and the state of the disease.ResultsSymptoms improved in the patient after the initial dose, decreasing the size and number of lesions. Three occasional exacerbations resolved without increasing the dose of adalimumab with the support of topical calcipotriol/betamethasone and tazarotene. No serious adverse events were reported.Conclusion and relevanceIn our case, treatment with adalimumab was safe and effective. Adalimumab could be a useful alternative in the treatment of severe recalcitrant disease or when there are contraindications to traditional systemic agents, such as pregnancy, a history of liver/kidney disease or uncontrolled hypertension. In order to assess the efficacy and safety of biologic medications, larger controlled studies are needed.References and/or acknowledgementsNo conflict of interest.