title: Successful treatment of palmoplantar pustulosis with isotretinoin.
abstract: OBJECTIVE
  Variably considered as a localized subtype of pustular psoriasis, palmoplantar pustulosis (PPP) is commonly treated with topical steroids, acitretin, and local phototherapy with oral or topical psoralen (PUVA). The utility of acitretin for PPP is limited by adverse effects such as myalgias and an extended risk of teratogenicity in female patients. Isotretinoin is a more tolerable retinoid with a shorter teratogenic window, but to date its effectiveness in PPP has not been reported. Herein we present two patients with PPP who responded well to isotretinoin treatment.
  
  
  METHODS
  Two patients with PPP refractory to topical therapies were started on acitretin. Both patients developed adverse effects (including headache, myalgias, and mood alterations) leading to acitretin discontinuation. Isotretinoin monotherapy was started in one patient resulting in significant clearing of palmar plaques and scale, and the addition of isotretinoin to UVA therapy resulted in near-complete clearing of recalcitrant plantar plaques in the second patient.
  
  
  CONCLUSIONS
  Acitretin represents an important treatment for PPP, but is limited by adverse effects and extended teratogenicity. Our experience supports the utility of isotretinoin as a potential therapeutic alternative, which may be particularly beneficial in patients who are poor candidates for or unable to tolerate acitretin therapy.
authors.forename: Reason
authors.initials: R
authors.lastname: Wilken
authors.forename: Ajay
authors.initials: A
authors.lastname: Sharma
authors.forename: Forum
authors.initials: F
authors.lastname: Patel
authors.affiliation: University of California Davis Medical Center. emaverakis@ucdavis.edu.
authors.forename: Emanual
authors.initials: E
authors.lastname: Maverakis
mesh_terms: D017255:Acitretin / Q000009:adverse effects / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001706:Biopsy; D002117:Calcitriol / Q000031:analogs & derivatives / Q000627:therapeutic use; D002518:Ceramides / Q000627:therapeutic use; D002784:Cholesterol / Q000627:therapeutic use; D002990:Clobetasol / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003951:Diagnostic Errors; D004338:Drug Combinations; D057915:Drug Substitution; D004485:Eczema / Q000175:diagnosis; D004643:Emollients; D005227:Fatty Acids / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015474:Isotretinoin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D014467:Ultraviolet Therapy
chemical_list: D000893:Anti-Inflammatory Agents; D002518:Ceramides; D004338:Drug Combinations; D004643:Emollients; C539259:EpiCeram; D005227:Fatty Acids; C055085:calcipotriene; D002784:Cholesterol; D002990:Clobetasol; D015474:Isotretinoin; D002117:Calcitriol; D017255:Acitretin