A pilot study of medium-dose cyclosporine for the treatment of palmoplantar pustulosis complicated with pustulotic arthro-osteitis

Pustulotic arthro-osteitis (PAO), which is one of the most intractable complications of palmoplantar pustulosis (PPP), is resistant to conventional therapies such as oral administration of NSAIDs. The main purpose of this study was to assess the effectiveness of cyclosporine for treating PPP with PAO. Seven patients affected by PPP with PAO were enrolled, and were treated with cyclosporine at medium doses ranging from 2 to 3 mg/kg/day. The severity of the skin lesions was scored by the modified PASI and pain scores at 0, 2, 4 and 8 weeks after the initiation of treatment, were assessed. QoL was assessed by SF-8 (TM) at 0 and 8 weeks. The average dose of cyclosporine used was 2.48 mg/kg/day. Each pain score improved statistically significantly at the indicated times after the initiation of treatment (P < 0.05). The QoL score improved significantly with a good correlation with the relevant pain scores. The modified PASI scores also decreased gradually, but were not statistically significant. No serious adverse events were observed in this study. These results suggest that a medium dose of cyclosporine is effective for treating PPP with PAO and markedly improves the patient QoL.