CASE REPORT article
Front. Med.
Sec. Dermatology
From Apremilast to JAK Inhibitors: Salvage Treatment Strategies for Refractory Palmoplantar Pustulosis: case series
Yufeng Pan 1,2
Di Jin 2
Fanzhang Meng 3
Hanlu Zhang 1,2
Jia-Nong Tang 4
Cui Guo 1,2
Jingjing Ma 2,5
Chen Li 6
1. School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, China
2. Department of Rheumatology, Weifang People’s Hospital, Weifang, Shandong, China
3. School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
4. Beijing University of Chinese Medicine, Beijing, China
5. Weifang People’s Hospital, Shandong Second Medical University, Weifang, Shandong, China
6. Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
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Abstract
Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease characterized primarily by recurrent episodes of blisters and sterile pustules on the palms and soles. Its course is chronic and recurrent, often accompanied by skin barrier disruption and intense itching or pain, significantly impairing patients' quality of life. Currently, there is no standardized treatment protocol for PPP. Conventional therapies include topical corticosteroids, immunosuppressants, and localized phototherapy, which offer limited efficacy and are prone to recurrence. With advances in research, targeting the immune system has gradually become the core of treatment. Biological agents (e.g., IL-23/IL-17 monoclonal antibodies, IL-36 receptor antagonists) and small-molecule drugs (JAK inhibitors, PDE4 inhibitors) have gradually been adopted in clinical practice and have achieved satisfactory therapeutic outcomes. In recent years, Apremilast (APR) has shown good response in the treatment of PPP in phase II and III clinical trials for patients with poor response to traditional treatments. However, this article reports nine special cases where the efficacy of APR was poor, and after switching to Tofacitinib (TOF), significant improvement in palmoplantar lesions was observed.
Summary
Keywords
apremilast (APR), JAK inhibitors, Palmoplantar Pustulosis (PPP), PDE4 inhibitors, Tofacitinib
Received
19 November 2025
Accepted
06 February 2026
Copyright
© 2026 Pan, Jin, Meng, Zhang, Tang, Guo, Ma and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jingjing Ma; Chen Li
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