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Correspondence |

Treatment of Refractory Tumor Necrosis Factor Inhibitor –Induced Palmoplantar Pustulosis: A Report of 2 Cases

Derek H. Chu, BS; Abby S. Van Voorhees, MD; Misha Rosenbach, MD
Arch Dermatol. 2011;147(10):1228-1230. doi:10.1001/archdermatol.2011.275.
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Tumor necrosis factor (TNF) inhibitor –induced palmoplantar pustulosis (PPP) is an uncommon cutaneous eruption characterized by sterile pustules on the palms and soles, along with hyperkeratosis, erythema, scaling, and fissuring. While some cases can be treated conservatively, a subset of patients present with severe, refractory disease, even after discontinuation of the inciting medication and the addition of systemic biologic agents, resulting in a considerable detriment to their quality of life. We report 2 such cases and our unique treatment approach.

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Figure 1. Patient 1. A, Initial presentation of the feet. There are deep-seated vesiculopustules, erythema, scaling, desquamation, and fissuring of the plantar surfaces of the patient's feet. B, Initial presentation of the hand. There are scattered patches of erythema and scale with deep-seated pustules involving the palm and palmar surface of the patient's thumb. C, The feet after treatment with ustekinumab. The plantar surfaces are free of pustules, fissures, and erythema, and there is minimal scaling of the heels. D, The hand after treatment with ustekinumab shows complete clearance of disease.

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Figure 2. Patient 2. A, Initial presentation of the feet. There are deep-seated vesiculopustules, erythema, scaling, and fissuring of the plantar surfaces of the patient's feet. B, Initial presentation of the hands. There are erythema and scaling of the palms of both hands. C, The feet after treatment with ustekinumab. There are residual erythema and scale, and only scant pustules primarily involving the heels. D, The hands after treatment with ustekinumab. There is minimal residual scaling of the palms.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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