10.5826/dpc.1302a97
text/xml
2160-9381
2702
en
Chiara Perugini
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
anti-IL-23
Risankizumab for the Treatment of Palmoplantar Pustular Psoriasis: A Report of Two Cases
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-04-29
2022-07-14
2023-04-29
2023-06-05
e2023097
Dermatol Pract Concept
Chiara Perugini
2023/04/29
10.5826/dpc.1302a97
e2023097
Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
2160-9381
anti-IL-23
en
e2023097
Gargiulo L, Pavia G, Valenti M, et al. Safety of Biologic Therapies in Patients with Moderate-to-Severe Plaque Psoriasis and Concomitant Viral Hepatitis: A Monocentric Retrospective Study. Dermatol Ther (Heidelb). 2022;12(5):1263-1270. DOI:10.1007/s13555-022-00726-w. PMID: 35460018. PMCID: PMC9110615.
Risankizumab for the Treatment of Palmoplantar Pustular Psoriasis: A Report of Two Cases
https://dpcj.org/index.php/dpc/article/download/2702/2080
    Risankizumab for the Treatment of Palmoplantar
        Pustular Psoriasis: a Report of Two Cases
          Luigi Gargiulo1,2, Carlo Alberto Vignoli1,2, Giulia Pavia1,2, Alessandra Narcisi1,2,
                               Antonio Costanzo1,2, Chiara Perugini1


1 Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
2 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy



Key words: psoriasis, palmoplantar pustular psoriasis, risankizumab, biologics, anti-IL-23
Citation: Gargiulo L, Vignoli CA, Pavia G, Narcisi A, Costanzo A, Perugini C. Risankizumab for the Treatment of Palmoplantar Pustular
Psoriasis: A Report of Two Cases. Dermatol Pract Concept. 2023;13(2):e2023097. DOI: https://doi.org/10.5826/dpc.1302a97
Accepted: July 27, 2023; Published: April 2023
Copyright: ©2023 Gargiulo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: Antonio Costanzo has been a consultant and/or speaker for Abb-Vie, Almirall, Amgen, Janssen, Leo Pharma, Eli Lilly,
Galderma, Boehringer, Novartis, Pfizer, Sandoz, and UCB. Alessandra Narcisi has been a consultant and/or speaker for Abb-Vie, Almirall,
Amgen, Janssen, Leo Pharma, Eli Lilly, Boehringer, Novartis, Pfizer and UCB. Luigi Gargiulo, Carlo Alberto Vignoli, Giulia Pavia and
Chiara Perugini have nothing to disclose.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Dr. Carlo Alberto Vignoli, MD, Dermatology Unit, Department of Biomedical Sciences, IRCCS Humanitas Research
Hospital, Humanitas University, Rozzano (MI), Itlay. Tel: +39 0282244050 Email: c.alberto.vignoli@gmail.com




Introduction                                                             Case Presentation
Palmoplantar pustular psoriasis (PPPP), according to the                 We present 2 patients with PPPP who were successfully treated
ERASPEN (European Rare And Severe Psoriasis Expert Net-                  with risankizumab, an anti-IL-23 monoclonal antibody.
work) guidelines, is defined as primary, persistent (>3 months),              The first patient is a 32-year-old woman, affected by
sterile, macroscopically visible pustular eruption on palms              PPPP and plaque psoriasis since 2020. On clinical examina-
and/or soles [1,2]. It can present with or without concomitant           tion, we observed pustular lesions on the palms and soles
plaque psoriasis [2].                                                    (Figure 1) along with erythematous and scaly plaques on the
    The pathophysiology of this condition is not fully un-               scalp. Palmoplantar investigator global assessment (ppIGA)
derstood, both the innate and adaptive immune systems are                score was 3 on a 5-point scale. Psoriasis Area Severity ­Index
involved [2]. A primary role is played by the increased expres-          (PASI) was 5.2. As topical corticosteroids had previously
sion of interleukin-8 (IL-8) and by IL-17 related c­ ytokines            been ineffective, given the age of the patient, acitretin was
(including L-17A/F, IL-23A, IL-23 receptor). A role has been             not recommended. Because of the impact of the disease on
proposed also for the antimicrobial peptide LL-37, which                 her quality of life (Dermatology life quality index [DLQI]
may contribute to neutrophil recruitment by upregulating                 was 12), we prescribed risankizumab 75mg, two subcutane-
IL-8, IL-23, IL-17C, IL-1 [2]. Only limited data are available           ous injections at weeks 0, 4, and then every 12 weeks.
regarding the treatment of PPPP with biologics and no stan-                   After 16 weeks the patient returned showing only a slight
dardized guidelines have been published yet [3].                         improvement, but at week 28 we observed complete skin


Research Letter | Dermatol Pract Concept. 2023;13(2):e2023097                                                                           1
             Figure 1. (A,B) Sterile pustules on erythematous skin with moderate scaling on the left foot (A) and on the right palm
             (B) of a 32-year-old woman, before the start of the therapy.




    Figure 2. (A,B) Clinical appearance of the patient soles (A) and palms (B) after 28 weeks of therapy with risankizumab. Complete
    resolution of the pustules is observed, with the persistence of only slight erythema and scaling.



clearance, with a ppIGA of 0 (Figure 2). The patient to date              and case reports are available for guselkumab, secukinumab
has completed a year of therapy and she has maintained the                and apremilast, which have demonstrated a moderate effi-
remission.                                                                cacy [4]. We decided to prescribe risankizumab for multiple
    The second patient is a 47-year-old woman, affected                   reasons: our favorable experience with this drug, including
from PPPP since 2018, previously unsuccessfully treated                   a patient with a flare of generalized pustular psoriasis [5];
with acitretin. She had a history of hepatitis B with pos-                the high safety profile, even in patients with serological
itive anti-HBc and anti-HBs. On physical examination we                   evidence of viral hepatitis [6]; the high effectiveness on
observed erythematous, scaly patches on the palms and                     ­difficult-to-treat areas [5]. In the first patient, we observed
palmoplantar pustules (ppIGA=3, PASI=11.3). Given her                     a slower response compared to our experience with risanki-
comorbidities and the concomitant presence of plaque pso-                 zumab in psoriasis vulgaris, however this is expectable given
riasis, with the consensus of the hepatologist, we started                the resistance of these areas to treatment [5].
risankizumab. At week 16 she achieved complete skin clear-                    To our knowledge, the experience on the effectiveness of
ance and she has maintained the remission after two years                 risankizumab in PPPP is limited. Further data, corroborated
(ppIGA=3). Both patients had provided written consent for                 by longitudinal studies with higher numbers of patients, are
retrospective study of data collected during routine clinical             needed to assess the role of risankizumab and other biologic
practice (demographics, clinical scores).                                 drugs for the treatment of PPPP.



Conclusions                                                               References
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In scientific literature there is paucity of data regarding the               sus statement on phenotypes of pustular psoriasis. J Eur Acad
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moplantar subtype. A few data from real-life experiences                      .14386. PMID: 28585342.


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2. Uppala R, Tsoi LC, Harms PW, et al. “Autoinflammatory                 5. Borroni RG, Malagoli P, Gargiulo L, et al. Real-life Effective-
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Research Letter | Dermatol Pract Concept. 2023;13(2):e2023097                                                                             3
