Case Study: Guselkumab Shows Promise for Severe Recalcitrant Palmoplantar Pustulosis

Palmoplantar pustulosis
Palmoplantar pustulosis
A novel case study of a patient with severe recalcitrant palmoplantar pustulosis (PPP) treated with guselkumab is described.

Treatment of a patient with severe recalcitrant palmoplantar pustulosis (PPP) with guselkumab led to a near total clearance of palmoplantar skin and improvement in affected nails within 3 months, a European case study shows. This case study was described in a Dermatologic Therapy.

The study featured a 59-year-old woman who developed a PPP in 2006 but had no prior signs of plaque psoriasis, psoriatic arthritis, or psoriatic onycho-pachydermo-periostitis in her medical history. The patient received local and long-term systemic steroids at 10 mg/day as well as PUVA-photochemotherapy combined with acitretin. None of these treatments resulted in any sufficient improvement in her condition. Also, systemic treatments apremilast and cyclosporine had no efficacy, and intolerability to fumaric acid esters and methotrexate caused clinicians to interrupt further treatment with these agents, it was noted.

At presentation, the patient had multiple pustules on the palms of the hands and soles of the feet. In addition, the patient presented with acrodermatitis continua suppurativa featuring pustules located on the fingertips and dystrophic nails. Further examination of the patient’s medical history revealed use of acetylsalicylic acid and oxcarbazepine and a 3-pack year smoking history.

Clinicians decided to initiate guselkumab to address chronic recurring course of resisting pustules, plaques, and pruritus, all of which contributed to a decreased quality of life. Within 3 months of treatment initiation, a near-total clearance of palmoplantar skin wasseen in addition to significant improvements of onychodystrophy. The excellent response rate continued through the last presentation at approximately 8 months later.

A limitation of this study included its inclusion of only 1 case, which suggests larger randomized trials will be needed to verify results.

In spite of these limitations, the reporters of this case study wrote that “together with existing evidence we suggest that guselkumab may be effective in the treatment of Caucasian patients with severe recalcitrant PPP.”

Disclosure: Several of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of author’s disclosures.


Duderstadt S, Raap U, Patsinakidis N. Rapid therapeutic response of palmoplantar pustulosis under biologic treatment with guselkumab. Published online January 21, 2021. Dermatol Ther. doi:10.1111/dth.14792