Successful treatment of hand and foot psoriasis with infliximab.
Hand and foot psoriasis is a disabling condition associated with significant quality-of-life issues. It is characterized by hyperkeratosis and/or the development of recurrent crops of sterile pustules with associated erythema, fissuring, and scaling symmetrically localized on palm and soles. Systemic conventional therapies include retinoids, psoralen-UVA (PUVA), methotrexate, and cyclosporine. So far, only limited evidence supports the use of TNF-alfa blockers. Because there are reports of paradoxical induction of pustular psoriasis following the use or withdrawal of infliximab as well as other TNF inhibitors, the use of these agents in palmoplantar psoriasis has been cautioned. The authors describe the clinical characteristics and evolution of 4 adult patients with severe palmoplantar psoriasis who were treated successfully with infliximab. Patient data is available for a minimum of 10 months and as many as 16. One of them with concomitant HCV infection showed no increased viral replication or progression of liver disease for a follow-up of 10 months; afterwards infliximab was stopped because of an infusion-related urticaria. All other patients displayed a good clinical response (> or =PPPASI 50) and were still receiving this regimen at last observation. This report provides preliminary evidence to support a cautious use of infliximab in patients with palmoplantar psoriasis.
Di Lernia
Vito
V
Department of Dermatology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. vito.dilernia@asmn.re.it
Guareschi
Elisa
E
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D016572:Cyclosporine / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004062:DiGeorge Syndrome / Q000150:complications; D005235:Fatty Liver, Alcoholic / Q000150:complications; D005260:Female; D005533:Foot Dermatoses / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D006229:Hand Dermatoses / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D000069285:Infliximab; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D012176:Retinoids / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D012176:Retinoids; D016572:Cyclosporine; D000069285:Infliximab; D008727:Methotrexate