title: Ustekinumab in the treatment of palmoplantar pustular psoriasis - a case series of nine patients.
abstract: BACKGROUND
  Palmoplantar pustular psoriasis is a chronic inflammatory skin disease that is associated with considerable impairment in quality of life and resilience. Given the lack of approved pharmacological agents for this indication and the frequently recalcitrant disease course, therapeutic options are limited.
  
  
  METHODS
  Following unsatisfactory therapeutic attempts with other treatment modalities, nine patients (six women; three men) were treated with ustekinumab (45 mg in individuals < 100 kg body weight, 90 mg in individuals > 100 kg) at weeks 0, 4, 12, and 24. Latent tuberculosis was ruled out prior to treatment. Regular follow-up was done at week 4 and 12, and every 12 weeks thereafter.
  
  
  RESULTS
  Average age at the beginning of treatment was 48 years. Four patients achieved 75 % improvement in the palmoplantar Psoriasis Area Severity Index (PASI). Overall, there was an average improvement in the palmoplantar PASI of 71.6 % after 24 weeks. Two patients exhibited complete resolution after 24 weeks. Besides local injection site reactions and mild infections, no adverse effects were observed.
  
  
  CONCLUSIONS
  This case series provides further evidence for the effectiveness and tolerability of ustekinumab in the treatment of palmoplantar pustular psoriasis. Controlled studies and observations in the context of patient registries are required to assess long-term efficacy and safety as well as the potential therapeutic benefit of intermittent therapy.
authors.affiliation: Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Valeska
authors.initials: V
authors.lastname: Buder
authors.affiliation: Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Herberger
authors.affiliation: Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Arnd
authors.initials: A
authors.lastname: Jacobi
authors.affiliation: Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Augustin
authors.affiliation: Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Marc Alexander
authors.initials: MA
authors.lastname: Radtke
mesh_terms: D000328:Adult; D003879:Dermatologic Agents / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology*; D012867:Skin / Q000187:drug effects* / Q000473:pathology*; D016896:Treatment Outcome; D000069549:Ustekinumab / Q000008:administration & dosage*
chemical_list: D003879:Dermatologic Agents; D000069549:Ustekinumab