Question: I am diognosed palmoplantar pustulosis. I heard that Biotin can cure it. How do I take it?

While I was researching online about PPP, I came across these sites below, which gave me hope. I also found an XXXXXXX doctor treated her patient with different type of psoriasis with same approach but I am not able to copy the url. I have downloaded the pdf document but can't find a way to upload it. I have emailed Dr. Maebashi of Japan and he replied me. I am copying the email here.
Thank you
http://www3.ocn.ne.jp/~hpps/15th/palmoplantar.html
http://www3.ocn.ne.jp/~hpps/english/english.html

[My question to Dr. Maebashi
I am XXXXXX living in United States. I am diognosed for PPP through biopsy. I came across the information provided by Dr.XXXXXX about PPP over the internet. I would like to try his treatment but have few questions. I have been taking Fasamox (Alendonate Sodium) for bone health. I also take multi Vitamin and calcium with D3. Can I take all those while I take this Biotin treatment? I sent an email to XXXXXX for their product. I found Miyarisan on www XXXXXXX com, but not sure if the product is legitimate. I wish and hope that Dr. Masauru Maebashi can help me with questions I have. I appreciate your response. I got your email ID through the link below.
Thank you
XXXXXX]
His Answer
Dear Sir

Ｉhave studied about palmoplantar pustulosis (PPP), although it has been said as no ethiology and cure method. I discovered the etiology and cure method and I have been treating many patient.

Palmoplantar pustulosis (PPP) has been regarded as an incurable disease characterized by pustular eruptions on the palms and soles of the feet, and extrapalmoplantarily on the backs of the hands and insteps of the feet. In the United States, PPP are included in the category of psoriasis. But in other countries, the skin rashes are strictly classified with the shape, form, size and region to break out.

In many cases, the skin rashes are merely transformed by the conditions of skin and the regions to break out. If the skin rashes occur only on the thick skin areas, palms and soles of the feet, they may be called as PPP. If the rashes occur and develop on the thinner skin areas such as body and extremities, they may be called as psoriasis, or pustular psoriasis, even if the initiators and promoters to cause them are the same. Thus, the psoriasis-like rashes on the extrapalmoplantar (SCCH) areas are a variant of pustular eruptions.

PPP frequently accompanies various complications such as bone lesions, diabetes mellitus, IgA nephropathy, chronic thyroiditis and intestinal disorders. The incidence of the bone lesions is almost 100%, although the patient did not complain any pain. The main clinical symptoms of the bone lesions are severe chest pain extending to involve limited motion of the arms and shoulders. Also, severe low back pain occurs. In such a case, the disease is called as sternocostoclavicular hyperostosis (SCCH). Then PPP may be regarded as a mild form of SCCH and is not merely a skin disease but rather must be considered as one of the systemic diseases.

The incidence of the disease was one out of 400~500 persons at three institutions, respectively, which were located more than 350 km apart each other. The cause to break out this disease remained unknown, although local infection such as an inflammation of the tonsils or carious teeth, allergy derived from dental alloys or genetic abnormality had been proposed.

This disease tends to aggravate despite various treatments with corticosteroids, nonsteroidal anti-inflammatory drugs, antibiotics, vitamin D, retinoid, immunodepressant drugs, PUVA radiation and/or partial resection of the affected bones for alleviation of severe chest pain, but all of these trials were without any relief and produced undesirable side effects.

Clinical characteristics
There are two major clinical characteristics in patients with PPP. One of them is many rice grain-sized sterile eruptions that develop on the palms and soles of the feet with epidermal thickening and immunoglobulin A (IgA) deposition in the surrounding areas of the eruptions. The other is pains over the sternum, clavicles, upper ribs and their joints, resulting in shrugging the shoulders like V-shaped or coat-hanger shoulder with ankylosis of the joints. Spurs and osteophytes are formed on the vertebrae. In advanced cases, the bone lesions rapidly worsen, irrespective of the severity of the eruptions on the palms and soles. Also, there is an intensive accumulation of isotope tracer on bone scintigrams, which are suggestive of ankylosing spondylitis. Mandibular sclerosis is observed in all patients.

The disease frequently runs in families, but it is not associated with any specific HLA antigen. The possible correlation between smoking habits and the occurrence of PPP and high prevalence of smoking habits were found in the patients. Smoking ( including passive smoking )worsens the morbidity and markedly lessens the therapeutic effect of biotin, because it remarkably reduces serum biotin concentration and has a bad influence on the immune system. Also, raw egg white deprives the medical effect of biotin, because it disturbs the absorption of the vitamin from the intestine.

Biochemical, metabolic and immune characteristics
The patients had metabolic abnormalities and subsequent immune dysfunction as a result of biotin deficiency. Biotin plays an important role as a coenzyme of various enzymes related to the metabolism of glucose, fatty acids and branched-chain amino acids. Thus, its deficiency causes serious metabolic abnormalities and adversely affects immune function. In fact, low serum biotin concentration, impaired glucose metabolism, reduced serum levels of fatty acids and abnormal composition of serum amino acids were observed in the patients.

Other features of the patients include increased serum levels of α2-globulin and β-globulin, increased IgA level, marked increases of helper T lymphocytes, reduced numbers of suppressor T lymphocytes. These indicate hallmarks of abnormalities of immune function.) Also, an inverse correlation between helper T cells/suppressor T cells and serum biotin concentration was observed. (This means that biotin deficiency is implicated in the occurrence of immune dysfunction.) In cases with severe bone lesions, there occurred an increase of Th1/Th2 in T lymphocytes.

In accordance with the concept, rats fed on a biotin-deficient diet showed similar skin and bone disorders, metabolic abnormalities and immune dysfunction. These findings suggested the possible therapeutic efficacy of biotin to the patients.

Treatment
As mentioned above, various trials had been proposed. Corticosteroid ointments are able to relieve transiently pustular eruptions, but fail to cause clinical, metabolic and immune improvement. Nonsteroidal anti-inflammatory drugs (NSAIDs) are of no effect to correct the eruptions, although the patients might be temporally free of the chest pain or backache. Their long-use may be associated with rapidly developing arthropathy, because occurrence of immune dysfunction and inhibition of the synthesis of prostaglandins relating to bone remodeling. Antibiotics administration is off no effect even though the administration was continued.

Also, raw egg white deprives the medical effect of biotin, because avidin contained in the egg white disturbs the absorption of the vitamin from the intestine. Immunodeppresant drugs, such as cyclosporine, methotrexate and etretinate are of no therapeutic effect and disturb biotin therapy. Further, drugs with carbamide radical or ureido radical in their chemical structure, such as vitamin B group except biotin, block the absorption of biotin, resulting in uselessness of the biotin therapy. Other treatments, such as PUVA radiation and anti-TNFα, were without any relief and produced serious side effects.

The possible correlation between smoking habits and the occurrence of PPP and high prevalence of smoking habits were found in the patients. Smoking, including passive smoking, worsens the morbidity and markedly lessens the therapeutic effect of biotin, because it remarkably reduces serum biotin concentration and has a bad influence on the immune system.

Oral administration of biotin to the patients eliminates chest pain almost within 8 weeks. Abnormal bone shadows on radiographs shows normal figures after 2 to 3 year’s administration, if the bone damages are not advanced. Pustular eruptions disappear usually on the palms after 5 to 6 months and on the soles after 7 to 8 months. All of the biochemical and metabolic abnormalities were corrected soon. Immune dysfunction normalizes within 2 years. Complications, such as diabetes mellitus and IgA nephropathy, were also improved in a short time. Biotin administration produced no undesirable side effects

Biotin deficiency and intestinal microflora
In the patients, frequent episodes of severe constipation or diarrhea were observed prior to the occurrence of the disease. Serum biotin concentration remained to be low and unchanged even after oral administration of the vitamin. Since biotin is mainly produced by microflora in the intestine and absorbed from the intestine into the circulation. It is, therefore, suggested that biotin deficiency may be attributable to the proliferation of “harmful” microflora in the intestine to digest the vitamin. However, supplementary administration of a probiotic agent, Clostridium butyricum Miyairi (Miyarisan Pharmaceutical Ltd, Phone Nummber O3-3917-1191) to the biotin treatment significantly increased serum biotin concentration and maintained the concentration high enough to improve clinical manifestations and other disorders including complications, because the probiotic agent prevents the proliferation of the harmful microflora in the intestine and intensifies the therapeutic action of the vitamin with no evidence of hematological, renal and hepatic toxicity.

Supplementation of other probiotic agents such as Lactobacillus showed poor therapeutic effectiveness to the biotin treatment, because the agents require much biotin for their proliferation. Addition of antibiotics to the biotin treatment significantly increased serum biotin concentration with a faster onset of clinical improvement. However, the beneficial response to the treatment was not long-standing. Serum biotin concentration again decreased to the basal level despite continued treatment, and therapeutic effectiveness wore off; presumably by not only inhibiting the development of “useful” microflora to synthesize biotin but also promoting the proliferation of antibiotic-resistant “harmful” microflora, resulting in poor therapeutic benefit.

Conclusion
Patients with PPP had metabolic derangements of glucose and fatty acids as well as immune dysfunction derived from biotin deficiency, which led to abnormal manifestations of skin, bone and other tissues and organs. All of the clinical, metabolic and immune disorders were improved by biotin administration. These findings indicate that biotin deficiency was implicated in the outbreak and exacerbation of the disease and its complications.
Supplementary addition of a probiotic agent to the biotin treatment intensified the therapeutic effect of the vitamin. Additionally, patients with psoriasis vulgaris, systemic erythematosus, atopic dermatitis or rheumatoid arthritis also had biotin deficiency with the subsequent metabolic abnormalities and immune dysfunction, and so the biotin treatment provided beneficial effects in the therapy of the diseases, as in the case of PPP.

Addition;
Usually, I do not administer drugs such as Alendonate Sodium, because the drugs dose not useful abnormal manifestation of ossification related to PPP and SCCH.

Sinserely Yours,

Dr. XXXXXX

Thank you for your response. When I said Dr. from XXXXXXX it is exactly Dr. Metikurke Vijayashankar, Dr. Nithya XXXXXXX from XXXXXXX Banglore. I have the copy of their theses with me. I tried to contadct Dr. XXXXXXX XXXXXXX but no response. Since it is said she had stopped everything while administering biotin treatment and since Dr. Masaru Maebashi also clearly mentioned the other treatments are not helpful, It was my understanding that it is only Biotin treatment that cured. Now that I come to undetand your point, my further question is-- Do you treat me through online consultation? Thank you
XXXXXXX