Eight-Patient Case Series of Palmoplantar Pustulosis Treated Successfully With Apremilast
Bibliographic record
Abstract
Background: Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease characterized by sterile pustules, erythema, and scaling on the palms or soles of the feet. Apremilast is a systemic agent that inhibits phosphodiesterase 4 and is approved for the treatment of plaque psoriasis and psoriatic arthritis. Objective: To demonstrate the safety and efficacy of apremilast use in a small patient population with PPP. Methods: A retrospective review of medical charts between September 2008 and October 2017 identified 8 patients diagnosed with PPP and treated with apremilast; relevant literature was also reviewed. Results: The patient population was primarily female (3:1 female to male ratio), had comorbidities, and ranged in age from 39 to 66 years. Traditional PPP therapies were first attempted with limited or failure of response. All 8 patients responded to apremilast and currently remain on apremilast therapy ranging from 4 to 30 months of duration. Apremilast was effective either as monotherapy or in combination with ustekinumab or methotrexate. Minimal side effects were noted. Conclusions: This retrospective review demonstrates the potential for apremilast as a suitable systemic treatment option for PPP when conventional therapies fail or are contraindicated. Other studies have found similar results. Additional case series with larger patient populations or formal clinical trials would provide more definitive conclusions on the usefulness of apremilast in PPP.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".