Pustulosis palmaris et plantaris (PPP) is a common skin disease that is difficult to treat. We describe 7 patients with PPP in whom the oral administration of itraconazole proved highly effective.
The clinical data of 7 patients are summarized in Table 1. The patients included 3 men and 4 women ranging in age from 40 to 62 years at the start of administration of itraconazole. The duration of disease before administration of the drug ranged from 7 months to 30 years. All patients started to take itraconazole, 100 mg/d, as an initial dosage and the maintenance dosages were 50 mg/d in 4 patients and 100 mg/d and 50 mg/d alternately in 2 patients. Patient 7 continued to take the initial dosage of 100 mg/d for 6 months without changing to the maintenance dosage. The follow-up periods ranged from 4 weeks to 2 years. In all patients, pustules on the palms and soles appeared to stop forming within 2 weeks after the administration of itraconazole, and then the pustules completely disappeared during therapy. The erythematous-squamous lesions also improved, but they never healed completely. After discontinuation of the administration of itraconazole, all patients experienced relapses. Most recently, 2 patients (1 and 2) have taken the initial dosage of 100 mg/d for 2 weeks at the time of acute exacerbation, followed by the maintenance dose of 50 mg/d until they achieved stable remission. Three patients (5, 6, and 7) continue to take the maintenance dosage. Two patients showed normal regrowth of the fingernails and toenails (Figure 1). Two patients did not return for follow-up evaluation. No adverse effects were noted.
Mihara M, Hagari Y, Morimura T, Nakayama H, Ishihara M, Aki T, Inoue T. Itraconazole as a New Treatment for Pustulosis Palmaris et Plantaris. Arch Dermatol. 1998;134(5):639-640. doi: