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Background: Difficult-to-treat palmoplantar psoriasis has a disproportionately negative impact on quality of life., Objective: We evaluated the efficacy and safety of apremilast in palmoplantar psoriasis., Methods: A post hoc analysis of data pooled from phase IIb (PSOR-005) and phase III (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM] 1 and 2) clinical studies was conducted to determine the effect of apremilast 30 mg twice daily versus placebo at week 16 in a subset of patients with moderate to severe plaque psoriasis with active palmoplantar psoriasis (baseline Palmoplantar Psoriasis Physician Global Assessment [PPPGA] score ≥1)., Results: Significantly more patients taking apremilast with moderate to severe palmoplantar psoriasis (baseline PPPGA score ≥3) achieved PPPGA score 0 (clear) or 1 (almost clear) compared with placebo at week 16 (48% vs 27%; P = .021). At week 16, 46% of the apremilast group with baseline PPPGA score 1 or higher achieved a PPPGA score of 0 versus 25% of the placebo group (P < .001); 59% of the apremilast group had a PPPGA score of 0 or 1 with 1-point or more improvement versus 39% receiving placebo (P < .001)., Limitations: This post hoc analysis was limited to 16 weeks and did not assess palmoplantar pustules, lesion localization, or surface area involvement., Conclusion: Apremilast may be a useful oral treatment option for patients with moderate to severe palmoplantar plaque psoriasis., (Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Psoriasis is a chronic inflammatory disease associated with comorbidities and decreased quality of life. This survey is aimed to better understand the impact of disease on Canadian patients, and to examine awareness and use of available treatment options., Methods: An online survey was conducted using a consumer panel. Eligible subjects reported diagnoses of psoriasis and moderate/severe/very severe plaque psoriasis within the past 5 years, and either: psoriasis covering ≥ 3% of body surface area; psoriasis on a sensitive area, or current use of systemic and/or phototherapy or light therapy for psoriasis., Results: A total of 514 panelists completed the survey; 65% reported current moderate/severe/very severe psoriasis. Awareness of available treatment options ranged from 98% for prescription topical agents to 75% for photo/light therapy, and < 50% for prescription oral (49%) or injectable (35%) medications. A total of 92% of respondents had been treated with and 61% were currently taking prescription topical agents. Photo/light therapy had been used by 38% and was currently used by 7% of respondents. Prescribed oral medication had been taken by 25% and was currently used by 8%. Few subjects had been treated with injectables in the past (10%) or currently (5%). Overall, 24% of respondents were very satisfied with their current treatment. A total of 63% of respondents taking injectables were very satisfied, compared with 38% of those taking prescribed oral medication and 21% of those receiving photo/light therapy.Conclusions Most respondents with moderate to severe psoriasis were unaware of all treatment options; systemic treatments were not commonly utilized. Treatment satisfaction rates were low, highlighting the need to ensure greater patient education on and use of available therapeutic options.

Background: Minocycline-induced cutaneous pigmentation is an adverse effect that may be more common than is generally realized. It is usually reported in patients undergoing chronic minocycline therapy for acne vulgaris., Objective: The case of a 69-year-old woman taking minocycline for rheumatoid arthritis is presented, and its differential diagnosis discussed in order to characterize the clinical features of minocycline-induced cutaneous pigmentation., Conclusion: Patients undergoing minocycline therapy for rheumatoid arthritis may develop bluish-grey pigmentation over the legs and forearms. Cutaneous pigmentation is a well recognized adverse effect of minocycline therapy that is usually reported in young patients on chronic therapy for acne vulgaris. However, the antiinflammatory properties of minocycline have also made it useful in the management of various inflammatory conditions such as rheumatoid arthritis.1 We report the case of a 69-year-old woman who developed progressive cutaneous pigmentation, affecting mainly the legs, approximately 3 months after beginning minocycline therapy for rheumatoid arthritis.