Novel trial designs being advocated for rare diseases, such as the use of historic controls, employing validated treatment outcomes and avoiding concurrent systemic therapies, are now justified to establish the place of JAKis in the treatment of this important, high-need disease where treatment options remain profoundly limited. All patients had previously received biologic therapies without benefit, and 15 had previously failed to respond to standard systemic therapies, underscoring the treatment-recalcitrant nature of PPP. Are Janus kinase inhibitors an effective treatment for palmoplantar pustulosis? In 4 of the 16 cases, systemic cotherapy with oral steroids ( I n i = 2) and methotrexate ( I n i = 2), in addition to ongoing topical therapy (in at least two cases), may have contributed to this treatment effect. [Extracted from the article]