Palmoplantar pustular psoriasis treated with etanercept

Abstract

Palmoplantar pustular psoriasis (PPPP) is one of the clinical presentations of psoriasis, often difficult to treat, can be used several topical and systemic. The use of anti-tumor necrosis factor alpha (anti-TNFα) in the treatment of pustular forms of psoriasis is controversial, with a variable clinical response, outside this class of biological medication may trigger pustular psoriasis. CASE REPORT: Patient 60, female, white, with a diagnosis of PPPP for 12 years and psoriatic arthritis for 6 years. Relevant personal history: hypertension, hypertriglyceridemia and obesity. Presented refractory to topical treatments (corticosteroids and emollients) and systemic (methotrexate, dapsone, colchicine and acitretin), having evolved with excellent response to treatment with etanercept (administered weekly by subcutaneous injection at a dose of 50 mg). DISCUSSION: The anti-TNFα are effective in the treatment of psoriasis in moderate to severe plaque. But, in the treatment of PPPP is not classically recommended. According to the literature, the therapeutic response with this type of drug is variable in PPPP. In addition, anti-TNFα may trigger clinical of palmoplantar pustulosis. However, there are reports of therapeutic success with anti-TNFα in refractory cases of PPPP. Due to patient’s comorbidities, and after having exhausted the possibilities classical therapies, we chose the use of etanercept, which proved effective. The patient began treatment in April 2008 and keeps the use of etanercept until the present date, being in remission. CONCLUSION: We emphasize the possibility of using anti-TNFα in patients with PPPP refractory to conventional treatment. In our case, etanercept was effective and safe, not having the patient presented any serious adverse events