We read with interest the RCT by Reich et al., and we found that the conclusion given: “this study provided no evidence to support further exploration of alitretinoin in the treatment of severe palmoplantar pustulosis (PPP)” should be carefully interpreted.1 The authors found no significant difference in the percentage change in PPPASI between the alitretinoin (45.2% ±32.8 of improvement) and placebo (44.6%, ±45.9), 95% CI rate difference -31% to 32%.1 This article is protected by copyright. All rights reserved.