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A literature review in identified several drugs most effective in clearing palmoplantar psoriasis. None were effective in clearing palmoplantar pustulosis.

A total of 15 studies reported that eight drugs afforded clearance of palmoplantar psoriasis compared with placebo: adalimumab, apremilast, bimekizumab, etanercept, guselkumab, ixekizumab, secukinumab, and ustekinumab. The top treatments were guselkumab, bimekizumab, and adalimumab.

For palmoplantar pustulosis, researchers ultimately included data from seven randomized controlled trials, collectively comprising five drugs (apremilast, imsidolimab, guselkumab, spesolimab, and ustekinumab). However, no drug was more effective than placebo for disease clearance or improvement of this condition.

Co-author Wilson Liao, MD, is a professor and associate vice chair of research with the University of California San Francisco (UCSF) department of dermatology. He also serves as director of the UCSF Psoriasis and Skin Treatment Center. Liao's exchange with the Reading Room has been edited for length and clarity.

What was the intent of this study?

Liao: Topical therapies and phototherapy often fail to improve palmoplantar psoriasis and palmoplantar pustulosis. However, the comparative efficacy of biologic and oral agents in people with these two conditions is not well established.

This study compared the effectiveness of different treatments for palmoplantar psoriasis and palmoplantar pustulosis. Both conditions greatly affect the health and well-being of affected individuals. This review was designed to facilitate treatment decisions for a patient population that experiences disproportionate detriment to quality of life.

The study used a statistical method called network meta-analysis, which allows comparison of treatments that have not been studied head-to-head.

Would you summarize your key findings?

Liao: For palmoplantar psoriasis, guselkumab, bimekizumab, and adalimumab were the three most effective drugs for achieving skin clearance. For palmoplantar pustulosis, no drugs were found to be better than placebo in achieving skin improvement or clearance.

Did anything about the study surprise you?

Liao: I was surprised that none of the drugs were found to be effective for palmoplantar pustulosis.

What are the key take-home messages for dermatologists?

Liao: All the treatments studied for palmoplantar psoriasis helped to some degree -- especially guselkumab, bimekizumab, and adalimumab. For palmoplantar pustulosis, we need better treatment options.

This study adds to our knowledge about the effectiveness of treatments for two important subtypes of psoriasis.