In this video blog, Vaneeta Sheth, MD, discusses highlights from her lecture, Cases in the Clinic, on July 26, 2024, during the inaugural Elevate-Derm Summer Conference at the Westin Copley Place in Boston, Massachusetts.
In this video
Dr. Sheth points to guselkumab as the biologic with the greatest effectiveness for palmar plantar pustulosis, noting that a significant proportion of patients in randomized controlled trials achieved meaningful improvement in their PPPASI scores. She's quick to flag the practical hurdle: insurance coverage for these newer agents often requires step therapy, as it did with her patient. She also reminds clinicians not to forget the older agents used before biologics — acitretin has been very helpful in her hands, and cyclosporine can be an option for patients who need to be "cooled down quickly" when there are no contraindications.
Describing herself as "more of a lumper than a splitter," Dr. Sheth workups and treats these patients much like plaque psoriasis patients, but cautions that they don't respond as well or as quickly — so a bit more up-front patient education about timelines helps. In her own cohort followed over the last five years, she hasn't seen a significant increase in joint pain, suggesting these patients aren't necessarily higher risk for psoriatic arthritis than other types.
- Among biologics, guselkumab has shown the greatest effectiveness for palmar plantar pustulosis, with significant PPPASI improvement in RCTs.
- Expect insurance step-therapy requirements to slow access to newer agents.
- Don't overlook older options — acitretin can be very helpful, and cyclosporine works to cool patients down quickly when there are no contraindications.
- Workup mirrors plaque psoriasis, but counsel patients that response tends to be slower and less complete.
- In Dr. Sheth's five-year cohort, palmar plantar pustulosis did not carry a notably increased risk of psoriatic joint involvement.
