Publications by authors named "Ari M Goldminz"

28 Publications

  • Page 1 of 1

Contact dermatitis.

Nat Rev Dis Primers 2021 05 27;7(1):38. Epub 2021 May 27.

Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.

Contact dermatitis (CD) is among the most common inflammatory dermatological conditions and includes allergic CD, photoallergic CD, irritant CD, photoirritant CD (also called phototoxic CD) and protein CD. Occupational CD can be of any type and is the most prevalent occupational skin disease. Each CD type is characterized by different immunological mechanisms and/or requisite exposures. Clinical manifestations of CD vary widely and multiple subtypes may occur simultaneously. The diagnosis relies on clinical presentation, thorough exposure assessment and evaluation with techniques such as patch testing and skin-prick testing. Management is based on patient education, avoidance strategies of specific substances, and topical treatments; in severe or recalcitrant cases, which can negatively affect the quality of life of patients, systemic medications may be needed.
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http://dx.doi.org/10.1038/s41572-021-00271-4DOI Listing
May 2021

Occupational dermatitis to facial personal protective equipment in health care workers: A systematic review.

J Am Acad Dermatol 2021 Feb 1;84(2):486-494. Epub 2020 Oct 1.

Duke Dermatology, Duke University Medical Center, Durham, North Carolina. Electronic address:

Background: Prolonged wear of facial protective equipment can lead to occupational dermatoses.

Objective: To identify important causes of occupational dermatoses from facial protective equipment.

Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using PubMed and Embase databases. Articles were included if they reported occupational dermatoses caused by surgical/procedure masks or N95 respirators, or both.

Results: We identified 344 articles, and 16 were suitable for inclusion in this review. Selected articles focused on facial occupational dermatoses in health care workers. Allergic contact dermatitis to the elastic straps, glue, and formaldehyde released from the mask fabric was reported. Irritant contact dermatitis was common on the cheeks and nasal bridge due to pressure and friction. Irritant dermatitis was associated with personal history of atopic dermatitis and prolonged mask wear (>6 hours). Acneiform eruption was reported due to prolonged wear and occlusion. Contact urticaria was rare.

Limitations: Only publications listed in PubMed or Embase were included. Most publications were case reports and retrospective studies.

Conclusion: This systematic review from members of the American Contact Dermatitis Society highlights cases of occupational dermatitis to facial protective equipment, including potential offending allergens. This work may help in the diagnosis and treatment of health care workers with facial occupational dermatitis.
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http://dx.doi.org/10.1016/j.jaad.2020.09.074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528888PMC
February 2021

Allergic contact dermatitis in a wastewater treatment worker: The role of sodium hypochlorite.

Contact Dermatitis 2020 Dec 19;83(6):533-535. Epub 2020 Oct 19.

Harvard Medical School, Boston, Massachusetts, USA.

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http://dx.doi.org/10.1111/cod.13707DOI Listing
December 2020

Cross-sectional evaluation of the pediatric baseline series in detection of contact sensitization in children.

J Am Acad Dermatol 2021 Apr 17;84(4):1123-1126. Epub 2020 Jun 17.

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.06.046DOI Listing
April 2021

Alcohol-Related Dermatitis: A Review.

Dermatitis 2020 May/Jun;31(3):185-190

Department of Dermatology, Brigham and Women's Hospital, Boston, MA.

: Wine, beer, liquor, and spirits are widely consumed in many cultures across the globe, and for some individuals, ingestion, cutaneous contact, or other exposure can lead to dermatologic findings. However, there currently exist no comprehensive reviews on alcohol-related dermatitis. Herein, we will provide an overview of alcohol-related dermatitis and contact urticaria, including the epidemiology and clinical manifestations, potential allergens found in alcoholic beverages, testing approaches, and strategies for allergen avoidance.
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http://dx.doi.org/10.1097/DER.0000000000000579DOI Listing
March 2021

Allergic Contact Dermatitis of the Eyelids: Swimming Past Goggle Dermatitis.

Dermatitis 2020 Mar/Apr;31(2):e12-e13

Department Dermatology, Brigham and Women's Hospital, Contact Dermatitis and Occupational Dermatology Program, Chestnut Hill, MA.

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http://dx.doi.org/10.1097/DER.0000000000000541DOI Listing
December 2020

Feeling the Burn: Phototoxicity and Photoallergy.

Dermatol Clin 2020 Jan;38(1):165-175

Harvard Medical School, Boston, MA, USA; Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA. Electronic address:

An interaction between light's radiation and certain exogenous and endogenous substances can lead to the development of photoallergic and/or phototoxic dermatoses. Clinically, reactions may range from acute and self-limited to chronic and recurrent. Delays in diagnosis are not uncommon due to complex clinical presentations, broad differentials, and limited number of specialists who perform phototesting. Therefore, a critical understanding of these dermatoses is essential for accurate diagnosis and appropriate management. The epidemiology, light sources, mechanisms, clinical presentations, evaluation protocols, common culprits, treatments, key challenges, and future directions related to photoallergy and phototoxicity are reviewed herein.
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http://dx.doi.org/10.1016/j.det.2019.08.010DOI Listing
January 2020

Preventing relapses of airborne allergic contact dermatitis to isothiazolinones in wall paint by painting over with an isothiazolinone-free paint.

Contact Dermatitis 2020 Feb 28;82(2):130-131. Epub 2019 Nov 28.

Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.

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http://dx.doi.org/10.1111/cod.13411DOI Listing
February 2020

Don't forget the sponge.

Contact Dermatitis 2019 Aug 12;81(2):149-150. Epub 2019 Apr 12.

Department of Dermatology, Brigham and Women's Hospital, Chestnut Hill, Massachusetts.

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http://dx.doi.org/10.1111/cod.13270DOI Listing
August 2019

"Pink Sign": The Importance of Short-Term Occlusive Testing in Suspected Cases of Contact Urticaria.

Dermatitis 2019 Mar/Apr;30(2):168-169

From the Department of Dermatology, Brigham and Women's Hospital, Boston, MA.

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http://dx.doi.org/10.1097/DER.0000000000000441DOI Listing
September 2019

Comparison of Nickel Sulfate 2.5% and Nickel Sulfate 5% for Detecting Nickel Contact Allergy.

Dermatitis 2018 Nov/Dec;29(6):321-323

From the Department of Dermatology, Brigham and Women's Hospital, Chestnut Hill, MA.

Background: Nickel is among the most common contact allergens found on patch testing worldwide and, because of its ubiquitous nature in our environment, often has important implications for allergen avoidance strategies. In both North America and Europe, nickel positivity is found in approximately 20% of patients who undergo patch testing. Whereas in North America, nickel sulfate is typically tested at a concentration of 2.5%, in Europe, it is tested at a 5% concentration.

Objective: The primary objective was to assess the differences in patch test positivity to nickel sulfate 2.5% and 5%.

Methods: We investigated 205 consecutive patients between September 2017 and February 2018 who were tested to nickel sulfate at concentrations of both 2.5% and 5%.

Results: Among the 205 patients tested, 33% were positive (+, ++, or +++) to at least 1 concentration of nickel sulfate, 20% were positive to nickel sulfate 2.5%, and 31% were positive to nickel sulfate 5% (χ1(N = 205) = 16.1, P = 0.0001). Patients were 6.5 times more likely to have a positive reaction to nickel sulfate 5% than 2.5% (odds ratio 95% confidence interval, 2.3-25.6).

Conclusions: Given our findings, we propose an additional evaluation of nickel sulfate 5% as a standard allergen for patch testing in North America.
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http://dx.doi.org/10.1097/DER.0000000000000419DOI Listing
March 2019

A case series of dupilumab-treated allergic contact dermatitis patients.

Dermatol Ther 2018 11 24;31(6):e12701. Epub 2018 Sep 24.

Department of Dermatology, Brigham & Women's Hospital, Chestnut Hill, Massachusetts.

Atopic dermatitis is characterized by skin barrier abnormalities and immune dysregulation with increased T 2 signaling playing a central role. Investigations of allergic contact dermatitis suggest that certain allergens may also activate particular T cell signatures such as T 2-dominant responses to fragrance and rubber. We present a case series of patients with allergic contact dermatitis who were successfully treated with dupilumab, a biologic developed for atopic dermatitis that dampens T 2 signaling. In our cohort of three patients, two had extensive allergic contact dermatitis on their torso and extremities primarily due to textile and rubber allergens. The third was a hairdresser with severe hand dermatitis due to occupational allergens. Two of the three patients had no history of atopic dermatitis during childhood. Each patient experienced at least 90% improvement in body surface area involvement and continues to maintain their clinical response on dupilumab (range 6-13 months). Our hypothesis that dupilumab suppressed contact allergic reactions is supported by the identification of clinically relevant contact allergens on patch testing, acute onset and/or worsening of dermatitis in adulthood, and absence of childhood atopic dermatitis in two cases. Further, larger investigations to understand which factors affect responses of allergic contact dermatitis to dupilumab are warranted.
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http://dx.doi.org/10.1111/dth.12701DOI Listing
November 2018

Positive Occluded Patch Test in the Face of Negative Repeat Open Application Test.

Dermatitis 2018 May/Jun;29(3):162-163

From the Brigham and Women's Hospital, Boston, MA.

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http://dx.doi.org/10.1097/DER.0000000000000372DOI Listing
October 2018

Psoriasis.

Nat Rev Dis Primers 2016 11 24;2:16082. Epub 2016 Nov 24.

Department of Dermatology, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, New York 10595, USA.

Psoriasis is a chronic, immune-mediated disorder with cutaneous and systemic manifestations and substantial negative effects on patient quality of life. Psoriasis has a strong, albeit polygenic, genetic basis. Whereas approximately half of the accountable genetic effect of psoriasis maps to the major histocompatibility complex, >70 other loci have been identified, many of which implicate nuclear factor-κB, interferon signalling and the IL-23-IL-23 receptor axis. Psoriasis pathophysiology is characterized by abnormal keratinocyte proliferation and immune cell infiltration in the dermis and epidermis involving the innate and adaptive immune systems, with important roles for dendritic cells and T cells, among other cells. Frequent comorbidities are rheumatological and cardiovascular in nature, in particular, psoriatic arthritis. Current treatments for psoriasis include topical agents, photo-based therapies, traditional systemic drugs and biologic agents. Treatments can be used in combination or as monotherapy. Biologic therapies that target specific disease mediators have become a mainstay in the treatment of moderate-to-severe disease, whereas advances in the treatment of mild-to-moderate disease have been limited.
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http://dx.doi.org/10.1038/nrdp.2016.82DOI Listing
November 2016

Adalimumab for the treatment of actinic granuloma.

Dermatol Ther 2017 May 29;30(3). Epub 2016 Sep 29.

Department of Dermatology, Tufts Medical Center, Boston, Massachusetts, USA.

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http://dx.doi.org/10.1111/dth.12432DOI Listing
May 2017

High-dose ustekinumab for the treatment of severe, recalcitrant pyoderma gangrenosum.

Dermatol Ther 2016 Nov 9;29(6):482-483. Epub 2016 Aug 9.

Tufts Medical Center, Boston, MA, USA.

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http://dx.doi.org/10.1111/dth.12387DOI Listing
November 2016

Insights on methotrexate in psoriatic disease.

Clin Immunol 2016 Nov 25;172:61-64. Epub 2016 Jul 25.

Tufts University School of Medicine, 136 Harrison Avenue, Boston, Massachusetts, 02111, USA. Electronic address:

The folic acid analogue methotrexate is used as an anti-neoplastic agent and treatment for inflammatory disorders including psoriasis, dermatomyositis, lupus erythematous, sarcoidosis, and systemic sclerosis. Despite the introduction of newer biologic agents, methotrexate remains a first-line systemic therapy for many patients with disorders of chronic inflammation. Here we briefly describe the current clinical evidence for methotrexate use in psoriatic disease, our current understanding of methotrexate's anti-inflammatory properties, and the future role of methotrexate in the treatment of immune mediated disorders.
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http://dx.doi.org/10.1016/j.clim.2016.07.008DOI Listing
November 2016

Psoriasis Trends and Practice Gaps.

Dermatol Clin 2016 Jul;34(3):235-42

Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box 114, Boston, MA 02111, USA.

The present article addresses several high-impact practice gaps affecting psoriatic patients, current practices, the barriers that prevent the delivery of optimal care, and recommendations to improve patient outcomes. Discussions of treatment, cardiovascular risk factor screening, psoriatic arthritis screening, and biologics are included. Finally, an overview of current resident exposure to psoriatic care and recommendations for improvements in resident education are made.
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http://dx.doi.org/10.1016/j.det.2016.03.004DOI Listing
July 2016

Apremilast and Secukinumab Combined Therapy in a Patient With Recalcitrant Plaque Psoriasis.

J Drugs Dermatol 2016 May;15(5):648-9

We report a 67-year-old Caucasian man with a long-term history of recalcitrant plaque psoriasis and psoriatic arthritis who was initiated on a treatment regimen of apremilast and secukinumab after failing multiple topical, photo, and systemic therapies. This combination provided significant skin improvement with minimal drug side effects.

J Drugs Dermatol. 2016;15(5):648-649.
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May 2016

Methotrexate improves pro- and anti-atherogenic genomic expression in psoriatic skin.

J Dermatol Sci 2016 Jun 9;82(3):207-9. Epub 2016 Mar 9.

Department of Dermatology, Tufts Medical Center, Boston, MA, United States, United States.

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http://dx.doi.org/10.1016/j.jdermsci.2016.03.007DOI Listing
June 2016

CCL20 and IL22 Messenger RNA Expression After Adalimumab vs Methotrexate Treatment of Psoriasis: A Randomized Clinical Trial.

JAMA Dermatol 2015 Aug;151(8):837-46

Department of Dermatology, Tufts Medical Center, Boston, Massachusetts.

Importance: Methotrexate is a first-line systemic agent for treating of psoriasis, although its onset of effects is slower and overall it is less effective than tumor necrosis factor blockers.

Objective: To differentiate the response of psoriatic disease to adalimumab and methotrexate sodium.

Design, Setting, And Participants: Single-center, randomized, assessor-blind, 2-arm clinical trial of 30 patients from the outpatient dermatology center of Tufts Medical Center, enrolled from August 18, 2009, to October 11, 2011. Patients aged 18 to 85 years with chronic plaque-type psoriasis, a minimum Physician Global Assessment score of 3 (higher scores indicate more severe disease), and a psoriatic plaque of at least 2 cm were randomized in a 1:1 fashion to receive subcutaneous adalimumab or oral methotrexate. Skin biopsy specimens obtained at baseline and weeks 1, 2, 4, and 16 were given a histologic grade by blinded assessors to evaluate treatment response. Analyses were conducted from April 16, 2013, to January 5, 2015.

Interventions: A 16-week course of subcutaneous adalimumab (40 mg every 2 weeks after a loading dose) or low-dosage oral methotrexate sodium (7.5-25 mg/wk).

Main Outcomes And Measures: Changes in genomic, immunohistochemical, and messenger RNA (mRNA) profiles.

Results: Methotrexate responders experienced significant downregulation of helper T-cell-related (T(H)1, T(H)17, and T(H)22) mRNA expression compared with methotrexate nonresponders. Comparisons among adalimumab-treated patients were limited by the number of nonresponders (n = 1). Between adalimumab and methotrexate responders, we found no significant differences in gene expression at any study point or in the expression of T-cell-related mRNA at week 16. Adalimumab responders demonstrated early downregulation of chemokine (C-C motif) ligand 20 (CCL20) mRNA (mean [SE] at week 2, -1.83 [0.52], P < .001; week 16, -3.55 [0.54], P < .001) compared with late downregulation for methotrexate responders (week 2, 0.02 [0.51], P = .96; week 16, -2.96 [0.51], P < .001). Similar differences were observed with interleukin 22 (IL22) mRNA showing early downregulation for adalimumab responders (week 2, -3.17 [1.00], P < .001; week 16, -3.58 [1.00], P < .001) compared with late downregulation for methotrexate responders (week 2, -0.44 [0.68], P = .64; week 16, -5.14 [0.68], P < .001). Analysis of variance findings for key mRNA and immunohistochemical marker expression over the study course were significant only for CCL20 (P = .03) and IL22 (P = .006) mRNA comparing adalimumab and methotrexate responders.

Conclusions And Relevance: Methotrexate is an immunomodulator with effects on helper T-cell signaling in psoriasis. Similar genomic and immunohistochemical response signatures and levels of mRNA downregulation at study completion among adalimumab and methotrexate responders suggest a disease-driven instead of therapeutic-driven pathway regulation. Adalimumab and methotrexate responses are differentiated by patterns of normalization of CCL20 and IL22 mRNA expression and may explain the varied onset and degree of clinical responses by each treatment.

Trial Registration: clinicaltrials.gov Identifier: NCT00932113.
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http://dx.doi.org/10.1001/jamadermatol.2015.0452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5788701PMC
August 2015

Noninfectious granulomatous dermatitides: a review of 8 disorders (Part 1 of 3).

Semin Cutan Med Surg 2013 Sep;32(3):177-82

Tufts Medical Center, Department of Dermatology, 800 Washington St, Box 114, Boston, MA 02111, USA.

In this review we focus on 2 of the noninfectious granulomatous dermatitides, granuloma annulare and interstitial granulomatous dermatitis (the remaining 6 will be discussed in Parts 2 and 3), with an overview of their clinical and histological presentations, differential diagnoses, and treatment options. The disorders we discuss are polymorphic in their clinical and histopathological presentations, follow chronic or undulating disease courses, and are typically recalcitrant to therapeutic interventions. Although the clinical history may be helpful, careful and thorough histopathological examination is required. Established treatment algorithms for these disorders are lacking, and no randomized, placebo-controlled studies have been published. Future investigations should focus on the evaluation of larger cohorts, not only to establish treatment recommendations in randomized, placebo-controlled trials, but also to reach a greater understanding of disease pathogenesis and clinical-pathological presentation.
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http://dx.doi.org/10.12788/j.sder.0028DOI Listing
September 2013

Congenital subungual melanocytic nevus with a pseudo-Hutchinson sign.

Dermatol Online J 2013 Apr 15;19(4). Epub 2013 Apr 15.

Department of Dermatology, Tufts Medical Center, Boston, Massachusetts.

We describe a 29-year-old woman with congenital melanonychia striata and compound nevus of the right first digit. There was extension of the hyperpigmentation onto the proximal nail fold, even beyond the borders established by the band of melanonychia striata. A dermal plaque with irregular borders and variegated pigmentation was also present over the distal digit extending from the pigmented region of the hyponychium. A limited number of biopsy proven congenital subungual melanocytic nevi have been reported in the literature. Interestingly, we found that the majority of these cases present with longitudinal melanonychia in association with periungual hyperpigmentation, constituting a pseudo-Hutchinson sign. Currently studies evaluating the diagnostic test characteristics of Hutchinson sign are lacking. While Hutchinson sign is traditionally considered a worrisome feature it is certainly not pathognomonic and a malignant cause should not be assumed without thorough assessment.
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April 2013

Prevalence of the metabolic syndrome in children with psoriatic disease.

Pediatr Dermatol 2013 Nov-Dec;30(6):700-5. Epub 2013 Sep 9.

Tufts University, School of Medicine, Boston, Massachusetts.

Adults with psoriasis have a greater risk of developing metabolic syndrome (MetS) and cardiovascular disease (CVD), but few studies have investigated the prevalence of MetS and other risk factors for CVD in children with psoriasis. In an assessor-blinded study, 20 children ages 9-17 years with a current or previously documented history of psoriasis involving 5% or more of their body surface area or psoriatic arthritis were compared with a cohort of age- and sex-matched controls with benign nevi, warts, or acne. MetS, our primary endpoint, was defined by the presence of abnormal values in at least three of the following measures: triglycerides, high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), waist circumference, and blood pressure. Secondary endpoints included high-sensitivity C-reactive protein (hs-CRP), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C). Thirty percent (6/20) of children with psoriasis met the criteria for MetS, compared with 5% (1/20) of the control group (p < 0.05). Subjects with psoriasis had higher mean FBG (91.1 mg/dL) than the control group (82.9 mg/dL) (p = 0.01). There were no statistically significant differences in the other four components of MetS, BMI, BMI percentile, hs-CRP, TC, or LDL-C. The results of this trial demonstrate that children with psoriasis have higher rates of MetS than age- and sex-matched controls. It may therefore be important to evaluate children with psoriasis for components of MetS to prevent future CVD morbidity and mortality.
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http://dx.doi.org/10.1111/pde.12218DOI Listing
August 2014

Phosphodiesterase 4-targeted treatments for autoimmune diseases.

BMC Med 2013 Apr 4;11:96. Epub 2013 Apr 4.

Department of Dermatology, Tufts Medical Center, 800 Washington Street #114, Boston, MA 02111, USA.

Advancements in phosphodiesterase (PDE)-targeted therapies have shown promise in recent years for treating patients with a variety of autoimmune diseases. This review summarizes the development of PDE4 inhibitors and the associated literature with a focus on treatments for autoimmune diseases. After the initial investigations of the prototypic PDE inhibitor, rolipram, more selective inhibitors targeting the PDE4 isozyme have been developed. With phase II and phase III clinical trials currently underway to evaluate the safety and efficacy of the latest generation of PDE4 inhibitors, namely apremilast, a new class of treatments may be around the corner for patients suffering from chronic, autoimmune diseases.
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http://dx.doi.org/10.1186/1741-7015-11-96DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616808PMC
April 2013

Investigator-initiated, open-label trial of ustekinumab for the treatment of moderate-to-severe palmoplantar psoriasis.

J Dermatolog Treat 2013 Jun 8;24(3):179-87. Epub 2012 May 8.

Department of Dermatology, Tufts Medical Center, Boston, MA 02111, USA.

Background: Palmoplantar psoriasis is a variant of psoriasis resistant to many forms of treatment.

Methods: Twenty subjects with moderate-to-severe psoriasis of the palms and soles, 50% with pustules at baseline, were treated with ustekinumab at weeks 0, 4, and 16. All subjects had previously failed topical corticosteroids. Dosing was 45 mg subcutaneously for subjects weighing <100 kg and 90 mg for subjects weighing ≥100 kg. The primary endpoint was the percent of subjects achieving clinical clearance at week 16, defined as Palm-Sole Physician's Global Assessment ≤1. The study received Tufts Medical Center IRB approval.

Results: After 16 weeks of treatment, 35% (7/20) of subjects achieved clinical clearance. Sixty percent (12/20) improved two or more points on the Palm-Sole Physician's Global Assessment scale. Sixty-seven percent (6/9) of those receiving the 90 mg ustekinumab dose achieved clinical clearance compared with nine percent (1/11) receiving 45 mg (p = 0.02). At 24 weeks, mean values showed 56% improvement in Dermatology Life Quality Index, and 34% improvement in pain Visual Analogue Scale score (all p < 0.05).

Limitations: Assessment tools for palmoplantar psoriasis are not yet validated. Five subjects withdrew or were lost to follow-up.

Conclusion: This study demonstrates that ustekinumab dosed at 90 mg is effective in controlling signs and symptoms of palmoplantar psoriasis.
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http://dx.doi.org/10.3109/09546634.2012.672710DOI Listing
June 2013