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Introduction. Despite the availability of effective biologic therapies for psoriasis, there is no gold-standard treatment for nonpustular palmoplantar psoriasis (ppPsO). Methods. G-PLUS, a phase IIIb, double-blind, placebo-controlled, multicentre clinical trial, randomised adults with moderate-to-severe nonpustular ppPsO and limited plaque psoriasis (Psoriasis Area and Severity Index (PASI) ≥3 but <10) to guselkumab (an interleukin-23p19 blocker) or placebo. Placebo participants were crossed over to receive guselkumab at week (Wk) 16. The primary efficacy endpoint was the proportion of participants achieving palmoplantar PASI (ppPASI) 75 response at Wk16; clinical, biomarker, and quality-of-life endpoints were assessed through Wk48 and safety through Wk56. Results. At Wk16, ppPASI75 response was achieved by 35.9% of the guselkumab participants compared with 28.2% in the placebo group, resulting in a 7.7% difference in response rates (95% confidence interval: −11.5 and 24.7), which was not statistically significant (p = 0.533). More pronounced numerical improvements favouring guselkumab were observed for more stringent efficacy endpoints, such as Wk16 palmoplantar Investigator's Global Assessment (ppIGA) 0/1 response (guselkumab 34.6% vs. placebo 15.4%). Through Wk48, further improvements were observed in ppPASI75 response (55.1% and 64.1%) and ppIGA 0/1 response (42.3% and 48.7%) for the guselkumab and placebo-crossover groups, respectively. Dermatology Life Quality Index responses showed comparable trends at both timepoints. Safety and pharmacodynamic findings were consistent with the established profile for guselkumab. Serum biomarker levels were significantly reduced with guselkumab and correlated with the baseline PASI score but not the ppPASI score. Conclusion. Although the primary endpoint was not met, analysis of stringent secondary endpoints and post hoc analyses showed numerical improvements favouring guselkumab at Wk16. There were no new safety signals. Further studies are warranted to better understand the impact of guselkumab treatment in patients with ppPsO. This trial is registered with NCT03998683. [ABSTRACT FROM AUTHOR]

GLO:ETZ/01jan21:dth14714-fig-0001.jpg PHOTO (COLOR): 1 Palmoplantar hyperkeratosis and itching of the patient with juvenile-onset PRP were improved with a PDE4 inhibitor. GLO:ETZ/01jan21:dth14714-fig-0002.jpg PHOTO (COLOR): 2 Erythema of chest and buttock of the patient with juvenile-onset PRP was improved with administration of PDE4 inhibitor. Furthermore, apremilast has been reported to be refractory in juvenile-onset PRP.5 While, this report suggests that apremilast could be an effective treatment for patients with circumscribed intractable juvenile-onset PRP without I CARD14 i mutation. [Extracted from the article]

Bullous pemphigoid (BP) is an autoimmune bullous disease characterized by antibodies against BP180 and BP230.1 Palmoplantar keratoderma (PPK) is defined as hyperkeratosis of palms and soles.2 Here we report three BP cases developing acquired PPK (Table 1) along with review literature. Gradually, BP lesions and PPK improved and 8 months later, she went on complete remission on minimal therapy (prednisolone less than 10 mg/day) (Figure 1B). (1) Given the eosinophilic and neutrophilic filtration in the pathology of the palmoplantar lesion in the present and former studies, and a high levels of IL-1 , IL-17A, IL-17F, IL-22, and TNF in the blister fluid of patients, it seems that the inflammatory response can induce a proliferative effect on keratinocytes, which is similar to the PPK seen in psoriasis. [Extracted from the article]

Dear Editor, Generalized pruritus is a common complaint in elderly, rarely due to Sezary syndrome. Bone marrow studies and immunohistochemistry of skin biopsy has been tabulated (Table 2). European organisation for research and treatment of Cancer consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome: update 2017. [Extracted from the article]

Pityriasis rubra pilaris (PRP) is a rare heterogeneous group of papulosquamous inflammatory disorders with unknown etiology. PRP is often resistant to many conventional therapies which has made more challenging on treatment. More recently, several studies have shown encouraging clinical results of secukinumab in the treatment of PRP in adult, but no studies have explored its effects in children. We herein report a 7‐year‐old boy with severe type V PRP responded rapidly to secukinumab monotherapy (150 mg once weekly) when conventional therapies have failed. The patient showed rapid and dramatic improvement of erythema, palmoplantar hyperkeratosis, scaling, and itching within only 5 weeks, with no adverse effects. Secukinumab could be considered as a treatment option for refractory PRP in children, as recently reported in adult. [ABSTRACT FROM AUTHOR]

Neither the etiology nor a reliable treatment for palmoplantar pustulosis has been clearly established. Ozone nanobubble (ONB) water, which is treated with nanosized ozone gas particles and has strong antimicrobial activity, has attracted attention as a future therapeutic option for palmoplantar pustulosis. Oral rinsing, particularly in the periodontal areas, with 10 to 20 mL ONB water for a couple of minutes per night, was prescribed to seven palmoplantar pustulosis patients, comprising five female and two male patients, for 6 months. Skin lesions were observed to be completely cured within a treatment period of approximately 3 to 4 months in six patients; the exception case was the one suspected of having pyorrhea. Rinsing the periodontal area with ONB water resulted in very effective suppression of skin lesions and showed promise as a new treatment method for palmoplantar pustulosis, which suggested the involvement of oral bacteria. [ABSTRACT FROM AUTHOR]

Palmoplantar psoriasis (PPP) is a chronic, inflammatory dermatosis of the palms and/or soles with significant morbidity. It is notoriously difficult to treat and unresponsive to traditional topical agents. We aim to compare the effect of oral methotrexate (MTX) monotherapy vs MTX plus narrowband ultraviolet light B (NB‐UVB) in the treatment of recalcitrant PPP. This was a comparative clinical trial involving 90 patients of PPP. Eligible patients were randomly assigned to one of the two treatment groups. We aim patients in group A received 10 mg oral MTX weekly, and patients in group B received oral MTX 10 mg weekly and NB‐UVB sessions twice weekly for 12 weeks. There was a statistically significant difference in reduction of modified PPP Area Severity Index (m‐PPPASI) of patients in MTX plus NB‐UVB at week 12. The mean m‐PPPASI at week 12 was 3.66 ± 2.11 in MTX plus NB‐UVB group and 6.51 ± 2.04 in MTX only group (P <.001). Marked improvement (m‐PPPASI 75) was achieved in 20 (44.44%) patients in MTX plus NB‐UVB group compared with 6 (13.3%) in MTX monotherapy group (P <.001). Combination of MTX and NB‐UVB phototherapy helps to attain a better clinical response (reduction in m‐PPPASI score) than MTX monotherapy in the treatment of recalcitrant PPP. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic immune‐mediated inflammatory skin disorder, with a prevalence of 2% to 3% worldwide. Psoriatic lesions affecting scalp, nails, palms, and soles are considered difficult‐to‐treat and require specific management. When psoriasis involves these areas, it may be considered more severe even if the lesions are not extensive. Adalimumab (Humira) is a fully human monoclonal antibody against tumor necrosis factor (TNF), administered via subcutaneous injection. It has already been used in the treatment of adults and children with moderate‐to‐severe chronic plaque psoriasis. In literature, few studies investigated its efficacy in difficult‐to‐treat areas, hence we conducted an observational prospective study of 24 weeks to assess its role in patients with difficult to treat psoriasis. We found out a significant improvement in nail and scalp psoriasis, while palmoplantar and genital psoriasis showed an improvement though not statistically significant. Therefore, adalimumab can be used in difficult‐to‐treat areas with great results, also allowing an improvement in the quality of life of affected patients, both adults and children. [ABSTRACT FROM AUTHOR]

GLO:ETZ/01mar21:dth14792-fig-0002.jpg PHOTO (COLOR): 2 PPP after 3 months treatment with guselkumab gl The treatment of PPP can be challenging especially in cases with moderate to severe activity and chronic relapsing course. PPP is most commonly treated with conventional therapies used for plaque psoriasis such as topical corticosteroids, PUVA-photochemotherapy (psoralen and UVA) and acitretin. The clinical efficacy of guselkumab concerning plaque psoriasis is well proven and superior to the tumor necrosis factor antagonist adalimumab (VOYAGE 1 and 2).6,7 However, there is little evidence in countries outside from Asia supporting its use for PPP treatment. [Extracted from the article]

Aquagenic acrokeratoderma (AK) is a rare, transient type of acquired palmoplantar keratoderma resulting from short‐term contact with water and characterized by white, transparent papules and plaques usually localized in the palmar regions of the hand. The pathogenesis of aquagenic acrokeratoderma is not fully understood and is assumed to be related to an increased salt concentration in the epidermal cells with an increase in the ability of stratum corneum to bind water. This report of patients developing AK following increased frequencies of handwashing in the COVID‐19 Pandemic Outbreak is intended to contribute to our understanding of the pathogenesis. [ABSTRACT FROM AUTHOR]

Our patient had involvement of the genitals along with lesions over the hands and feet. Hand-foot syndrome and seborrheic dermatitis-like rash induced by sunitinib in a patient with advanced renal cell carcinoma. [Extracted from the article]

We confirmed that serum CCL20 levels markedly increased (852 pg/mL) 2 days before guselkumab therapy started, and decreased as the eruption improved after the treatment (Figure 2C). In conclusion, treatment with guselkumab was effective in this patient with PRP refractory to conventional therapies. Although further clinical studies are required, serum CCL20 levels may be a useful marker indicating PRP disease activity and providing incentive to initiate treatments targeting IL-23-Th17-pathway. [Extracted from the article]

Dear Editor Paradoxical reactions during treatment with a biologic agent are defined by the appearance or exacerbation of a pathological condition that usually responds to this drug while treating another condition. It has shown good results in Hurley Stage II or III HS patients,4,5 with improvement after an average of 4.3 months; some of these patients had concomitant psoriasis.6-8 One randomized controlled trial evaluating the efficacy and safety of guselkumab in moderate to severe HS patients is underway.9 We are reporting herein a case of concomitant HS, paradoxical psoriasiform reaction to adalimumab and sacroiliitis that were successfully treated with guselkumab. [Extracted from the article]

Pityriasis rubra pilaris (PRP) is a rare inflammatory skin disease of unknown etiology and pathogenesis. Histological examination revealed alternating orthokeratosis and parakeratosis overlying a slightly acanthotic epidermis with infundibular keratinization and a sparse perivascular lymphocytic infiltrate, consistent with a PRP eruption (Figure 1B). Detailed skin biopsy results when available showed alternating orthokeratosis and parakeratosis overlying a slightly acanthotic epidermis with infundibular keratinization, characteristic of PRP. [Extracted from the article]

Nivolumab, a fully human IgG4 immune checkpoint modulator, binds to the programmed cell death 1 (PD‐1) receptor on T cells and blocks their inhibition. Thus, it increases the anticancer host immune response by allowing T cells to attack tumor cells. Although anti‐PD‐1 immunotherapy is typically well accepted, deregulation of immune tolerance caused by nivolumab may determine immune‐related adverse events, among which skin toxicities represent the most common. We report a case of severe new‐onset palmoplantar and nail psoriasis after receiving nivolumab treatment for metastatic melanoma. [ABSTRACT FROM AUTHOR]

Papillon‐Lefèvre syndrome (PLS) is a rare disorder characterized by diffuse palmoplantar erythematous, fissured hyperkeratosis, and aggressive periodontal disease that starts in the early periods of childhood. Periodontal disease occurs with the early loss of deciduous teeth at the age of 2 to 4 years, followed by the loss of permanent teeth during adolescence. Prosthodontics management of PLS patients is very complex and sometimes requires invasive therapeutic treatments. Early diagnosis is essential for correct treatment management avoiding the possibility that patients are early edentulous. Management could be a conventional periodontal treatment and pharmacological therapy but in severe cases, digital techniques, could be help the clinician for increased patient comfort and minimized tissue damage. [ABSTRACT FROM AUTHOR]

The Papillon- Lefèvre syndrome ( PLS) is a rare, autosomal recessive disease that manifests with palmoplantar keratoderma and destructive periodontitis resulting in early onset periodontal breakdown in deciduous and permanent dentition. Management of this condition is difficult. Here we report one 11-year-old consanguineous Muslim boy suffering from PLS. After failing to get any benefit from methotrexate, three cycles of acitretin, each for 2 months, were given 1 month apart. In each cycle, acitretin (25 mg) was given every other day. At the end of the third cycle, treatment was stopped for 4 months to observe the extent of relapse. Thereafter, acitretin (25 mg) was given twice weekly for 4 months and then the patient was followed up for 1 year. Treatment with acitretin resulted in excellent improvement of periodontitis, increase in the alveolar bone height, and periodontal attachment. Improvement remained stable at the end of 1-year follow-up. There was excellent (>75%) improvement in keratoderma at the end of active therapy. Mild worsening of palmoplantar keratoderma was noticed whenever the drug was stopped. It improved when the drug was restarted. Other areas remained stable. At the end of 1-year follow-up, good improvement (50%) in palmoplantar keratoderma was achieved. [ABSTRACT FROM AUTHOR]

We observed complete response of biologic therapy in 60% and partial response in further 20% of the patients. Diagnosis and response to treatment was evaluated by a senior physician at regular follow up visits: based on retrospective chart evaluation it was possible to score the clinical response as "complete response", "partial response", and "no/limited response." Patient No. 6 reported dyspnea after treatment with ixekizumab; however, we did not suspect an association to biologic therapy. [Extracted from the article]

Ectropion surgery might not be a long-term solution for harlequin ichthyosis The exact location of the left lower eyelid conspicuously changed to a lower position in February 2018, only 3.5 months after the surgery displaying a strong confirmation to delay performing another ectropion surgery for the right eye with less complications (Figure 3). On the other hand, Karadag presented four individuals with ichthyosis-related ectropion repair who revealed neither lagophthalmos nor corneal exposure after 23 ± 12.7 months of follow-up.5 However, none of them had harlequin ichthyosis. [Extracted from the article]

GLO:ETZ/01nov20:dth14442-fig-0001.jpg PHOTO (COLOR): 1 Botulinum toxin type A injection treatment in acquired asymmetric keratoderma: Dark-brown hyperkeratotic plaques on the ventral side of wrists (A) and dorsa of hands before treatment (B). However, in patients with incomplete response to BT-A injection, other treatment modalities such as topical emollient, retinoid and keratolyics can be added. 7 Koren A, Sprecher E, Reider E, Artzi O. A treatment protocol for botulinum toxin injections in the treatment of pachyonychia congenita-associated keratoderma. [Extracted from the article]

Richner-Hanhart syndrome (RHS, tyrosinemia type II) is a rare autosomal recessive inborn error of tyrosine metabolism that presents with multiple focal painful palmoplantar hyperkeratosis, mental impairment, and photophobia. 1995; 16 (1): 21 - 26. 3 Iskeleli G, Bilgec MD, Arici C, Atalay E, Ogreden T, Aydin A. Richner-Hanhart syndrome (tyrosinemia type II): a case report of delayed diagnosis with pseudodendritic corneal lesion. 9 Alian Z. Richner-Hanhart syndrome (tyrosinemia type II): a case report of delay diagnosis with hyperkeratotic lesions of palms and soles. [Extracted from the article]

Palmoplantar pustulosis is a chronic inflammatory disease which characterized by a eruption of sterile pustules on the palms and soles. Apremilast is an oral phosphodiesterase‐4 inhibitor which is approved for the treatment of chronic plaque psoriasis and psoriatic arthritis. However, no clinical trial has been performed to confirm the efficacy of apremilast for palmoplantar pustulosis yet. Moreover, there are very few cases of this disease treated with apremilast. Herein, we describe a case of a refractory palmoplantar pustulosis succesfully treated with apremilast. [ABSTRACT FROM AUTHOR]

Paradoxical reactions during treatment with biological agents may be defined as an appearance or exacerbation of a pathological condition that usually responds to this class of drug. Typical examples of paradoxical adverse effect are, among others, palmoplantar pustular and psoriasiform reactions or HS, in patients during a treatment of rheumatoid arthitis or IBD mainly. A few reports have been described an exacerbation of psoriasis1, palmoplantar pustular, or pustular psoriasis eruption with secukinumab. Marasca et al. highlights the immunological complexity that surrounds autoinflammatory diseases showing the potential double pathogenetic face of secukinumab in HS, describing a case of secukinumab‐induced HS and a case of HS caused by adalimumab treatment and controlled by secukinumab therapy. Real world evidence and results from clinical trials with secukinumab for HS, will possibly show the real role that anti‐IL‐17 drugs play in this complex disease. [ABSTRACT FROM AUTHOR]

Pachyonychia congenital (PC) is a rare genetic disorder of cornification and is classified into five types on the basis of keratin gene involved. There are no established treatment options available for PC. Sirolimus in both topical and oral form has been studied in management of PC. We report a young female with a novel genetic mutation in KRT6A gene who presented with painful palmoplantar hyperkeratosis and onychogryphosis, which was cosmetically disfiguring. She was prescribed oral sirolimus after all investigations. There was significant improvement in pain within a week. Pain relief was sustained at 1 year follow‐up with topical treatment only. Serial nail avulsion surgeries were also done with showed significant cosmetic improvement in the nails. Medical therapies can be combined with surgery for a better cosmetic outcome and improvement in patient quality of life. [ABSTRACT FROM AUTHOR]

The article offers information on a study regarding paradoxical case effects of psoriasis following adalimumab therapy. It mentions that Psoriasis was the most common adverse effect during anti-TNF-α treatment, followed by palmoplantar pustular psoriasis and psoriasis of the nail sometimes combined in the same patient.

Pityriasis lichenoides (PL) is a spectrum of inflammatory skin diseases which include PL et varioliformis acuta (PLEVA) and PL chronica (PLC) as two ends of the disease and rarely both entities can coexist on the same patient. Treatment options are based on case series‐reports, and anecdotes, and include topical corticosteroids, topical immunomodulators, systemic antibiotics (tetracycline, erythromycin), and phototherapy. Herein, we report a 13‐year‐old boy, exhibiting mixed manifestations of PLEVA and PLC lesions concurrently, with a rapid and dramatic response to azithromycin monotherapy. [ABSTRACT FROM AUTHOR]