Eingun James Song, MD: Tips, Tricks for Dermatologists Treating Palmoplantar Psoriasis

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In this discussion with E. James Song, MD, several unique clinical pearls for those in dermatology were described and had been drawn from Song’s Winter Clinical presentation.

In a new HCPLive interview, Eingun James Song, MD, associate chief medical officer and the director of clinical research at Frontier Dermatology, spoke with the editorial team about the contents of his presentation ‘Clinical and Therapeutic Pearls in Psoriasis.’

Song’s portion of this presentation, along with that of his co-presenters, had been given at the 2024 Winter Clinical Dermatology Conference in Hawaii.

“So, we first start with trying to define what is palmoplantar psoriasis and how this is a distinct entity from psoriasis vulgaris type, which is a common type with palmoplantar involvement,” Song began.

He noted that most of the available data on palmoplantar psoriasis comes from randomized controlled trials (RCTs) where patients have moderate-to-severe plaque psoriasis but also have palmoplantar involvement.

“That's a distinct type of psoriasis,” Song said. “And I think it's really important to make that clear, because these patients, they generally respond very well to whatever medication that we have. Whether it's a biologic or a small molecule inhibitor, when we compare that to patients who just have palmoplantar psoriasis, meaning they don't have it anywhere else, that's a distinct entity.”

Additionally, Song explained that dermatologists know this not just based on how such patients respond to treatment, but also from an immediate immunological standpoint when the cytokine profile is assessed. He added that it looks much different than people who just have psoriasis.

Then, Song discussed the topic of patients with plaque psoriasis with palmoplantar involvement, commonly doing well with most of the available therapies.

“Just to kind of put this into perspective, you could probably get patients to ‘clear’ or ‘almost clear’ over 80% of the time, now, with one of our newer advanced biologic therapies,” Song said. “When you look at pure palmoplantar psoriasis, maybe a third of the time is the likelihood of them getting clear or almost clear. So that clearly tells you there's a difference here.”

Song later went into subtyping palmoplantar psoriasis, discussing how important it can be to differentiate pure pustular type of palmoplantar psoriasis versus hyperkeratotic palmoplantar psoriasis as they respond differently as well.

“The former, pustular palmoplantar psoriasis, responds very well to acitretin, whereas with more of the hyperkeratotic type we find that methotrexate tends to work a little bit better,” Song explained. “So in an overall treatment approach for palmoplantar psoriasis, I would say that I like to start with an induction dose of either cyclosporine or intramuscular Kenalog, and we want to dose these patients fairly aggressively. So cyclosporine, 4 to 5 mgs per kg real body weight, and intramuscular catalog about a mg per kg.”

To find out more from Song’s discussion, view the full interview segment above.

The quotes contained in this summary were edited for clarity.