Episode 27 - Treatment survival in palmoplantar pustulosis

In this episode of BJD Talks, Sam and Meera discuss the article ‘Real-world evidence on palmoplantar pustulosis: patient characteristics, diagnostic challenges and predictive factors for treatment survival – a retrospective registry study’ by Graier et al. The full article can be accessed at https://doi.org/10.1093/bjd/ljaf394 

*This podcast was generated by an AI tool created by 67Bricks for the British Association of Dermatologists* 

Transcript

SPEAKER_01 0:00

Welcome to BJD Talks, the official podcast of the BJD. I'm Sam.

SPEAKER_00 0:04

And I'm Mira. In this episode, we will be discussing the article by Thomas Greyer at AL, Real World Evidence on Palmoplanta Postulosis, Patient Characteristics, Diagnostic Challenges, and Predictive Factors for Treatment Survival, published in October 2025 and included in the January 2026 issue.

SPEAKER_01 0:25

Palmoplanta postulosis or PPP is a rather stubborn condition affecting the palms and soles, but it's often overlooked. Patients can go years without a proper diagnosis.

SPEAKER_00 0:36

Indeed, the study found over half of PPP patients were initially misdiagnosed, commonly with eczema, resulting in an average diagnostic delay of nearly three years. That's quite impactful on quality of life.

SPEAKER_01 0:50

Another point to note is demographics. PPP predominantly affects women, roughly 74% of cases, and 78% smoked. There's likely a connection there. What do you think, Mira?

SPEAKER_00 1:02

It is intriguing. Smoking is associated with inflammatory responses and compromised skin barriers, which could aggravate the condition. However, it's not exclusive to women. The trend was just more pronounced in this cohort. More research is definitely needed.

SPEAKER_01 1:18

Turning to treatments, they analyzed nearly 400 therapy courses, covering phototherapy, conventional systemic therapies, and biologics. Biologics, particularly ustakinemab, were the standout, boasting a median treatment survival of 2.7 years.

SPEAKER_00 1:33

Yes, ustakinemab targets IL-12 and IL-23, which might explain its success. Yet the emergence of IL-23P19 inhibitors has begun shifting the tide, showing how rapidly the treatment landscape evolves.

SPEAKER_01 1:48

Still, across all treatments, the median survival was only 0.6 years. Phototherapy and conventional systemics fell far short compared to biologics.

SPEAKER_00 1:59

True. Factors like side effects, diminished efficacy, or secondary loss of response often explain why treatments are discontinued. The study also highlighted that patients with long-standing disease tended to persist with treatments longer, but this is likely due to the high number of patients receiving phototherapy in the early disease course. Moreover, those with comorbidities experienced higher discontinuation rates.

SPEAKER_01 2:25

It underscores the complexity of PPP. It's rarely just about the skin. Conditions like plaque psoriasis or psoriatic arthritis often complicate treatment strategies.

SPEAKER_00 2:37

Exactly. And while biologics seem like the best option here, they're still not specifically approved for PPP in many areas, such as most of Europe. This forces clinicians and patients to rely on off-label treatments.

SPEAKER_01 2:50

What's your take for clinical practice, Mira? Should we focus on early diagnosis or push to use biologics more prominently?

SPEAKER_00 2:57

Both are essential. Early diagnosis is crucial to prevent prolonged patient suffering and to initiate effective treatments without delay. Biologics, especially those targeting IL-12 or IL-23 pathways, should be strongly considered for challenging cases.

SPEAKER_01 3:14

Agreed. To sum up, today's discussion highlights just how complex PPP is, marked by diagnostic delays, comorbidities, and a lack of long-term treatment options.

SPEAKER_00 3:24

But there's hope.