The Effect And Mechanism Of Cyclosporine For Palmoplantar Pustulosis

Palmoplantar pustulosis(PPP)is a chronic recurrent disease confined to the palms and soles..It periodically occurs sterile pustules with keratosis and scales on the basis of erythema.At present,the etiology and pathogenesis of palmoplantar pustulosis are not clear,and there are many treatment methods,including topical corticosteroids,phototherapy,systemicimmunosuppressive therapy,anti-inflammatory therapy,etc.But there is no uniform drug to treat palmoplantar pustulosis effectively.60 cases of palmoplantar pustulosis were investigated in this paper.Among them,48 cases were treated with single cyclosporine combined with moisturizer,which effect was proved to be not very well,and the possible mechanism was discussed.Objective:To investigate the clinical effect and possible mechanism of single use of cyclosporine on palmoplantar pustulosis.Methods:1.We selected 60 cases of PPP according to clinical diagnosis.Clinical manifestations: Skin lesions are confined to palms and plantar,with aseptic pustules on the basis of erythema,keratosis,scales.Yellow pustules can evolve into brown spots.The lesions are more symmetrical,and the boundary is clear.They may be accompanied by a burning sensation,itching,dryness,pain,swelling.The course of the disease is prolonged and often recurrent.The histopathological features of PPP were single locular pustule with most neutrophils and a few mononuclear cells.There were neutrophil spongiform pustules around the single locular pustule,with the spinous layer thickening.Infiltration of neutrophils,lymphocytes and histocytes around the superficial dermal vascular plexus.Patients were given a single oral dose of cyclosporine 5 mg / kg / d,and the total amount was divided into two doses,combined with external use of moisturizer.Before,during and after treatment,liver and kidney function,ion,blood routine,blood glucose,blood lipid and blood pressure were detected to evaluate the adverse reaction of cyclosporine.Before and after 8 weeks of treatment,the patients were treated with modified pasi score(pppasi score),and the total score drop index was calculated to evaluate the therapeutic effect of cyclosporine.2.The epidemiological characteristics of palmoplantar pustulosis were summarized and analyzed.3.The expression levels of serum cytokine IL-17,IL-23 and TNF-a were observed before and 8 weeks after treatment.Results:1)In 48 cases of patients with PPP,4 cases were cured(8.3%),20 cases were excellent(41.7%),11 cases were improved(22.9%),10 cases were invalid(20.8%),3 cases were unknown.The total efficiency was 50%.The onset time was 15-30 days and the treatment time was 15 days-6 months.Adverse reactions included 6 cases of increased blood pressure,6 cases of frequent urination and nocturnal urine,6 cases of gastrointestinal reactions such as nausea and stomach discomfort,3 cases of increased body hair and 1 case of increased serum creatinine.These symptoms were all mild.Symptoms disappeared after drug withdrawal or symptomatic treatment in individual patients.2)The epidemiological characteristics of 60 cases of PPP were as follows: 9 were male,51 were female.Ages fluctuated between 18 and 79 years,and the mean age at onset was 49 years.Medical history lasted from 15 days to 20 years,and the mean duration was 2 years.Rural areas: city at 21:39,the proportion of occupations is the most middle-aged and old people who are unemployed andnext is the farmer.Most of the onset season is in summer,followed by winter,aggravated season is also in summer,followed by winter,and the disease was mostly associated with smoking,drink,mental stress,poor sleep,cold,spicy eating,seafood,beef and sheep meat food,contact detergent,exposure to pesticides,trauma,sun,and sweat.Stress was most common,followed by seafood or spicy foods and smoking.There was no history of dental or tonsillar infection.The proportion of metal insert was 22 / 60.The interval between dentures and ppp was 6 months to 10 years,with a n average of 4.6 years.Among them,2 cases developed in 1 year after inlaid tooth material and 11 cases in 1-5 years.There were 6 cases with family history of psoriasis,6 cases with acrodermatitis,5 case with psoriasis vulgaris.There was no ppp family history.There were 42 cases(70%)with nail,toe or nail and toe involvement.Among them,the most common cases were the combination of nail and toe involvement.There were 9 cases of hypertension,3 cases of hyperlipidemia,2 cases of thyroid nodules,1 case of hyperthyroidism,1 case of hypothyroidism,3 cases of diabetes,3 cases of allergic rhinitis,4 cases of coronary heart disease and 1 case of alopecia areata.3)The results showed that the concentration of serum IL-17 in patients with ppp was lower than that before treatment,but there was no significant difference.4)The concentration of serum IL-23 in ppp patients was significantly lower than that before treatment,and the di fference was statistically significant.5)he levels of serum TNF-a in the patients with ppp were significantly lower than those before treatment,and the difference was statistically significant.Conclusions:1)The effect of cyclosporine on palmoplantar pustulosis is ideal,safe and less adverse reactions.It is necessary to further expand the sample size and observe the curative effect.2)Palmoplantar pustulosis occurs mostly in middle-aged and elderly women,and more urban than rural.Mostly PPP belong retired unemployed people and farmers.The onset and aggravation occur in summer.Mental stress was the most common cause,followed by seafood or spicy foods and smoking.The history of dental and tonsil infectionwere not obvious in the pathogenesis of PPP.There may be some relationship between the sensitization of metal insert teeth and the incidence of PPP.PPP is also associated with psoriasis.The incidence of nail,toe or nail and toeinvolvement is high(70%).Among them,the most common cases were the combination of nail and toe involvement.Ppp may be associated with thyroid disease,cardiovascular disease,diabetes,allergic rhinitis.3)The mechanism of cyclosporine in the treatment of palmoplantar pustular disease may be related to the down-regulation of the expression of IL-17,IL-23,and TNF-a,especially the decrease of IL-23 and TNF-a.4)IL-17,IL-23 and TNF-a may be involved in the development of palmoplantar pustular disease.