Biologic therapies associated with development of palmoplantar pustulosis and palmoplantar pustular psoriasis: a systematic review

Int J Dermatol. 2023 Jan;62(1):12-21. doi: 10.1111/ijd.16064. Epub 2022 Feb 6.


Background: Palmoplantar pustulosis (PPP) and palmoplantar pustular psoriasis (PPPP) are chronic inflammatory skin conditions characterized by eruptions of sterile pustules on the palms and/or soles. Biologic use has been associated with PPP and PPPP development in the literature.

Objectives: To identify PPP and PPPP associated with biologics and summarize reported treatments and outcomes.

Methods: We systematically searched in MEDLINE and Embase for articles that reported PPP or PPPP during biologic treatment. After a full-text review, 53 studies were included for analysis.

Results: We identified 155 patients with PPP/PPPP onset during biologic treatment, with a mean age of 44.1 years and a female preponderance (71.6%). The most frequently reported biologics were adalimumab (43.9%) and infliximab (33.3%). IL-17 inhibitors, secukinumab (7.6%) and brodalumab (1.5%), were reported only in association with PPPP. Overall, 58.8% of patients had complete remission (CR) in 3.6 months and 23.5% had partial remission (PR) in 3.7 months. The most common treatments that led to CR were topical corticosteroids (n = 16) and biologic switching (n = 8).

Conclusions: Clinicians should anticipate PPP or PPPP as potential drug reactions to biologics such as adalimumab and infliximab. Large-scale studies are required to confirm our findings and further explore the pathogenesis for biologic-associated PPP and PPPP.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Acute Disease
  • Adalimumab / adverse effects
  • Adult
  • Biological Products* / adverse effects
  • Biological Therapy
  • Chronic Disease
  • Exanthema* / therapy
  • Female
  • Humans
  • Infliximab / adverse effects
  • Psoriasis* / pathology
  • Skin Diseases, Vesiculobullous* / therapy


  • Infliximab
  • Adalimumab
  • Biological Products