PPP (Palmoplantar Pustulosis)

[CalamityJane]

Hi Jane, in my last post yesterday I mentioned that I might try something else, do you think I should give the methotrexate a little longer to work its been 3 months and not alot of improvement,thanks for your time.

Hi again, our posts must have crossed. I think you need to ask your derm that question about the methotrexate. You could tell her about the Doxy/ Keflex as well, and see if she would be willing to give you a month's script worth of it. I've found most derms/docs very open to things that have helped other folks. And as you've read, there are quite a number here.

Make the most of the appointment! Write down your questions so you don't forget. I have to do that. It's so easy to get off-track.......

Jane

[greshar]

Hi there Jane, Have just been to see my derm and I must say I was a little nervous as to what she might want to do with me next, as you will know that I was going to ask her about the doxy,anyway I followed her in and she noticed that I had a list in hand thanks Jane that was a great help to me, I said I have brought a list with me & she said I like people to bring a list and then I relaxed. Well she looked at my feet,( both Jane) and said we will stop the mxt and blow me down she said we will try the doxy 1x100mg per day and increase if needed, also Diprosone 0.5% oitment for the flares, a timely appointment as our weather is a very hot 33 degrees in the land of the long white cloud ( n.z ). Now may I offer a tip that works well for me ,when my skin is very rough and I just cant seem to keep my hands off the dry skin ,I have got on e of those Buffers that you see the nail technician using to buff-up those false nails, well it works a treat and my feet feel so smooth after using it, have to be careful not to buff down to far and not to often, hope this helps someone thanks for listening all ,cheers.

[CalamityJane]

Hi greshar - thanks for the update! Well, blow me down too, that is very good news about the Doxy. The dosage is lower that I've taken _at_ l a day.

I usually start a course with 2 100mg tabs on first day (sometimes for 2 days), then 1 100mg tab twice a day for at least 2 weeks, depending if you see an improvement.

Your doc sounds very good, and reasonable, so perhaps she would up the dose?

The buffer sounds good also. I don't have all the hard skin, thankfully, but others do.

Please stay with us and let us know if you get a result from the Doxy. Fingers crossed you will! If it doesn't clear you, hopefully it will contain it.
 

Thank you for getting back to us and congrats!

Jane

[Sherrall]

Hi every one, I am new here, but not new to psoriasis as a whole. I have been dealing with pustule psoriasis from head down since I was a kid, and I am now in my late 40's. With the help of tanning beds, from time to time, when the flare is bad, and with the use of Dovonex and Elocom cream, been able to keep it under control.

Last Spring, I noticed getting it on the bottom of my feet, and under my finger nails, the creams did not help, and I hadn't used a tanning bed for years prior to this out brake.

I went to my Dr. and told her that the creams were not helping me on this new area, and she sent me to a derm, who did a biopsy of the left foot, and it turned out to be PPP. She sent me to a clinic down town, which took me over a hour one way to get to, two times a week, to get PUVA treatment.

I ended up allergic to the P part of the PUVA, which is the medicated soak before the UVA light, plus it was still getting worse. I have other medical issue, which was starting to flare up, because of the long trip twice a week, so I stopped going there and started going back to the tanning beds, just for a few min. at a time, I use the tanning beds for the psoriasis not to get a tan. I do have to pay for the full session, even though I only use about 1/4 of the time. But thats fine, its all so a lot less expensive then the light therapy clinics. So all in all, I think I am better off.

Well the PPP is still very active, and I have lost two nails so fare, and I think I will be losing one more in a matter of time. Plus walking is so very painful.

I am not able to work due to the other illness, but this PPP is all most worse then the other illness. It hurt so very much, and the itching is driving me crazy. Night is the worse. I do wear sock to bed, to help with me scratching, and to keep my sheets clean. Due to the creams I am using.

I see lots of you use this Doxy medication, I am not sure if this will be a choice for me, due to I am overly sensitive to medication, creams, soaps, well mostly every thing, including some foods. But not grass, or the out door type of things. Go figure.

I was wondering how many are able to work, with this?

And just wanted to be a part of a group where other understand what this is like. I have felt very much a lone with this, and have been very depress over it all.

Thanks so much for reading this long post, sorry. I do tend to chatter on.......

Gentle hugs, Sherrall

[CalamityJane]

Hello Sherrall, and welcome to the PPP thread on SC!

You have an awful lot to contend with it seems, and you have my sympathies.

The Doxycycline is in the Tetracycline family of antibiotics, so if you can take Tetracycline without a problem, you should be OK with the Doxy.

My PPP does not itch, but most do. There are anti-itch creams that help with that. Also Dermovate will help. You know most of this I know. Things help, but do not cure of course. Mine is in remission thankfully.

Regarding working - often is it the sort of job you do. One that's not standing on your feet of course. It can be very, very painful and sore, and I've not forgotten that believe me! If you are able to work it is a good thing because it takes your mind off the misery of your feet. It did for me anyway!

Are you still seeing a doctor, or derm? It does help to have somebody caring for you.

We are glad to have you hear with us. Read through the thread and see if there's anything you think would help you. There is much information here.

Jane

[fifipomp]

hi everyone, im new to writing here but i have been taking lots of tips from you all over the last six months! its great to hear that others have this problem and understand just how depressing it can be. i just wanted to share my experience with you all as it may be of some use to someone. i have had ppp for about six months now and i have finally found something that is working, fingers crossed! i have been prescribed a cream which is made-up by the pharmacist which consists of dermovate, salicylic acid and Propylene glycol. it may be worth asking your derm or doctor about this mixture because it is like a miracle cure for me. ive only been using it for 6 days and my hands are almost clear - pain, itch, pustules - all gone!! i hope this helps someone.
fifi x

[Sherrall]

Thanks for the welcome  CalamityJane. I am so happy to be here, and to learn. I have been reading back on this thread. There is so much good information to read.
Thanks.

Hi fifipomp, that sounds awesome. I would love to ask my Dr. about the cream. I am seeing my reg. Dr. this Wednesday, and I am sure she will probable want to send me to yet another Derm. for the last one, said I should be happy its only under 3 finger nails, and on my feet, that some have it all over.

I was like what, and then she said, she could not help me, and to go back to my family Dr. So that is what I am doing. I know my family Dr. will ask what amount of the different creams are in the mixture, so if you know, could you let me know.

Thanks, Sherrall

[fifipomp]

hi Sherrall,
the amounts of each ingredient as written on the prescription are -
6% sal acid, 44% prop gly and 200 dermovate cream.

hope it helps

[CalamityJane]

Hi Fifi, and welcome to the PPP thread on SC.

I'm so happy you have found something that is helping you. It's trial and error with PPP. PPP is genetic, like freckles, black hair etc., but there are things that can help enormously, and you have found one!

Perhaps your prescription will put your PPP into remission. Different things work for different folk, and there is not a sure cure "bullet". The more info we have the more we can pass on to new members. Remission is what we all aim for and often it is spontaneous, as is often with immune disorders; they wax and wane at (their) will. <sigh>.

Sherrall:

said I should be happy its only under 3 finger nails, and on my feet, that some have it all over.

The opportunity to visit another Derm is often not available to folks, so my inclination would be to accept that referral........and just see what it brings. The loss of nails is frequent with PPP, and I lost a big toe nail to it - but it has grown back in, yippee!

The "all over" PPP referred to, is extremely rare, and a critical situation to my knowledge.

To new members, please read this thread, and take what is helpful to you. There's much information here.

Thank you for joining us!

Jane

[CalamityJane]

Hi all, a PS to my other couple of posts, especially for the new SC members.

When the PPP becomes completely unmanageable, there are of course, the "big guns" as I call them........Methotrexate, Cyclosporine, Accuntane (Soriatane), Prednisone to name a few. These sometimes clear things quickly, but if they are not well-tolerated and have to be stopped, the PPP often flares. It's a delicate balance. The side-effects also can be worse than the condition *sigh*.....

Jane

[kgresko]

Hi Jane I am new to SC forum.

I am a life long sufferer of plaque psoriasis and you name the treatment and I have used it.  Most recently for the past 5 years I have had great success in using Enbrel injections.  It has kept my plaque ps under control since using it.

I had some sinus surgery Spring 2009 and was taking a lot of prednisone after the surgery.  About a month ago I developed what my derm called PPP where I had these little white bumps which formed on my palms and bottom of my feet.  With that I had horrible pains in my arms, neck and torso.  I was getting ready for a trip to Florida and went to see my derm and she told me that little could be done and that it was probably a delayed reaction to the prednisone.  So she prescribed the usual cortisone creams.  Wanting to golf in Florida I frantically went to my GP and he gave me a shot of kennelog along with a regimine of prednisone.  My derm warned me that it might come back again with a vengance.  Guess what it did and WOW this time the pain which was worse than my hands and feet.

PPP is new to me and have never had it before.  Do you or any of the SC fellow posters have any experience with PPP and successful treatments to share?  I am getting real desperate now and am not getting the attention from my derm.  My GP strongly suggested that I see a Rheumatologist.

Anyone feel free to respond to me with any ideas.

Thanks in advance.  Ken

[CalamityJane]

Hi Ken and welcome to the PPP thread of SC.

It is not surprising that your PPP was worse than ever after stopping the Prednisone. I hope you very gradually reduced the dose. However, even doing that it can still flare-up worse than before.

Each person is different in what helps them it seems. In our small group here we have had success with Doxycycline, an antibiotic in the Tetracycline family. There are a number of things that help, and the aim is to get it into remission. It's an auto-immune problem and does it's own thing as it wishes.

Some helpful things found in this thread:

Doxycline
Keflex
Wet wraps
Steroid Creams, (Dermovate, Clobetasol)
Tar
Dovonex
A really good moisturizer

If it is completely out of control, Accutane (Soriatain), Methotrexate. These sorts of drugs can have nasty side-effects, so to me they are a last ditch effort.  Enbrel I believe is also one used for PPP. Are you still on that?

Peruse this thread and you'll find lots of support and ideas along w/helpful hints!

Jane

[kgresko]

Thanks Jane.  I appreciate your comments.  The FDA has not approved Enbrel for the treatment of PPP, and since I am still doing the injections it appears not to help PPP.  It appears that my PPP has about a one week duration.  The little bumps on my hands and feet after they break, turn into little brown bumps and then I start feeling like a snake shedding its skin.  Each night I put on a moisturizer and then put on Clobetasol.  I put on socks on my feet and white gloves on my hands.  The peeling takes about a week until all the new skin is showing then I keep well moisturized (about 4 times a day).  Then assuming I take no more prednisone hoping the PPP will not return anytime soon.

On my last visit to the derm she told me of a new biologic called Stelara.  This has to be administered at the physicians office, unlike Enbrel which can be self administered.  I called Centocor Ortho Biologic, the maker of Stelara, and they indicated to me that it has not been approved for PPP.  This probably means that it was only tested and approved by the FDA for plaque PS.

Well thats all for now. 

[CalamityJane]

Hi Ken, good description of PPP! Mine you to do that cycle so often that fissures would appear across my sole causing much soreness and difficulty walking. Try the Clobetasol an hour before the moisurizer. You are doing the right thing keeping feet & hands covered.

PPP sometimes goes into spontaneous remission. Or in my case with the Doxy. If you can get some Doxy perhaps give it a try.

Take care all,,

Jane

[greshar]

Hello Jane,
               just letting you know that this is my 7th day on doxy and I am thrilled to bits with my feet, actually it was very noticeable by the 3rd day that their was going to be a change,I hope that this will continue to improve fingers crossed.

Is'nt it amazing that one medication will work over another especially when one so mild as doxy in comparison to acetretin or methotrexate as I was taking.

Thankyou Jane for your help and advise on this problem we all seem to suffer from ,it is so good to talk to people who understand the pain and misery of PPP.

I feel like jumping over the moon right now, well perhaps Ill just take a walk on the grass and enjoy thanks for listening.

Cheers Sharon
               

[CalamityJane]

Hi Sharon:

WOW, super news! I'm so happy for you! It's a wonderful feeling to see and feel a positive change in our feet. I understand your "jumping over the moon" feeling.  

The Doxy thing happened just by accident, but it has helped so many people just on this forum. Different things help different folk, but the Doxy success here is really quite remarkable.

Thank you so much for reporting back. These small studies are so important for us all now, and for the future of "feet with good skin".

Jane 

[fifipomp]

hi guys,
quick question,
when the ppp clears, how long does it take fo the skin to go back to normal. my ppp is still clear but my skin still feels like it is missing a few layers!!

[greshar]

Hi Jane & all,
                  Just a quick line to say my feet are in good shape apart from 1or2 pustules,also next week I have an app with my derm and

                  I will be asking her if I am able to increase the dose as I am only on 1x100 per day this might help get rid of those stubborn

                  pustules, gee I hope it lasts , anyway Jane you have a great event about to begin in your country so hope you have the

                  time to enjoy I know we will be watching as their are a few Kiwis over there. thanks for listening all. cheers Sharon

[zeb]

Hi all and welcome to all the new posters.

Same old same old here really.

Had a really bad flare over christmas and into Jan and it is really only just starting to clear. Still just using loads of moisturiser as nothing else really seems to make any difference. I am looking forward to spring as I have had real problems wearing any type of shoe lately.

Still haven't tried the doxy but if it starts to flare up again I will be straight down to the GP!

[CalamityJane]

Hi folks, good to hear from you all!

Sharon:

anyway Jane you have a great event about to begin in your country so hope you have the time to enjoy I know we will be watching as their are a few Kiwis over there

Thanks Sharon for your comment on the BC Olympics. People are very pumped up, and I'll be watching as I have the time, and taping the figure skating events, especially the dance! The world will be competing in all competitions it seems, and it's the culmination of years of hard work, no matter who gets the medals. Vancouver is a lovely and very friendly city. Bit large for me....but great for this super event.  I so wish the weather had cooperated. We have loads of snow on our Mount Washington on Vancouver Island. A base of 300+cm.

Do ask the doc for 100 mg. twice a day. That's the standard dose it seems to me, and more can be taken "under doc's advisement". Try to get enough for a longish course, 6 weeks or so. I wish you continued success! You have no idea how much my 'accidental' use of Doxy has amazed me. The list is getting longer of those helped by it.

Zeb - Hi - sorry you don't have better news. Spring brought me even more misery. The hotter it was (sandals or not) the worse my foot was. I can't remember exactly what you are doing for it, but it needs more than moisturizer. It needs to be occluded with steroid (Dermovate, etc.) all day and night if you can. Also, look up wet-wraps.

I'd be off to the doc's begging for Doxy.........In fact I did go begging....for Keflex (turned out I can't take it as it is in the Penicillin family)........The Doxy as I've said was prescribed for something else.

Fifi - your skin will repair at it's own pace. Keep it well moisturized. PPP feet, even when in remission, rarely feel like "normal" feet. That's my experience. Although there was a time when all was fabulous. Now, if the PPP is not active, no peeling or anything, that it fabulous!

Great to see you all here..........

Jane