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Palmoplantar Pustular Psoriasis: Clinical and Video Thermographic Evaluation Before and After Topical Tacrolimus Treatment

Luigi Laino, MD; Aldo DiCarlo, MD
Arch Dermatol. 2011;147(6):760. doi:10.1001/archdermatol.2011.120.
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Palmoplantar pustular psoriasis (PPP) is characterized by recurrent crops of sterile intraepidermal pustules, erythema, fissuring, and scaling confined to the palms and soles. It may represent a variant of psoriasis.We performed clinical and thermographic evaluations of PPP in 2 women (aged 47 and 53 years) using a third-generation thermographic instrument (FLIR3000; FLIR Systems AB, Danderyd, Sweden). We associated the newest PPP lesions (Figure 1A and Figure 2A) with thermographic “hot spots” (Figure 1A and B, plus signs) and the oldest lesions with thermographic “cold spots” (Figure 1A and B and Figure 2A and B, arrowheads). We also saw a hyperthermal area around the zone, suggesting subclinical inflammation (Figure 2A and B, asterisks indicate perilesional hyperthermic areas). After the lesions were treated with topical tacrolimus, 1% (twice daily for 1 month), we saw clinical resolution of the acute phase (Figure 3A and Figure 4A) and a significant decrease in the thermographic gradients (Figure 3B and Figure 4B). These results suggest that thermographic gradients can provide objective data that may have a role in accessing certain dermatologic conditions.

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