JAK inhibitors for the treatment of palmoplantar pustulosis: a narrative review
Abstract
Background: Palmoplantar pustulosis (PPP) is a chronic, relapsing skin condition characterized by sterile, pruritic pustules on erythematous, thickened skin of the palms and soles. It often causes painful fissures, leading to functional impairment and reduced quality of life. Due to its limited response to conventional therapies and biologic therapies, PPP remains a therapeutic challenge. Recent findings implicate both T helper 17 (TH17)-mediated and TH2-mediated inflammation, prompting interest in broader immunomodulatory treatments such as Janus kinase (JAK) inhibitors.
Methods: This narrative review evaluates current evidence on the efficacy and safety of JAK inhibitors in the treatment of PPP. Published studies involving tofacitinib, upadacitinib and baricitinib were identified and reviewed.
Results: Clinical improvements with JAK inhibitors have been reported, particularly in cases refractory to conventional systemic therapy. Findings include reductions in the Palmoplantar Pustulosis Area and Severity Index (PPPASI) and improvements in patient-reported quality of life, with a low incidence of adverse effects. An ongoing trial investigating deucravacitinib reflects growing interest in this drug class.
Conclusion: JAK inhibitors show promise as a novel therapeutic option for PPP, given their ability to modulate multiple inflammatory pathways. Although current evidence is limited to case series and reports, results are encouraging and warrant confirmation through well-designed clinical trials.
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