Association of Clinical and Demographic Factors With the Severity of Palmoplantar Pustulosis

Abstract

; for the ERASPEN consortium and the APRICOT and PLUM study team IMPORTANCE Although palmoplantar pustulosis (PPP) can significantly impact quality of life, the factors underlying disease severity have not been studied. OBJECTIVE To examine the factors associated with PPP severity. DESIGN, SETTING, AND PARTICIPANTS An observational, cross-sectional study of 2 cohorts was conducted. A UK data set including 203 patients was obtained through the Anakinra in Pustular Psoriasis, Response in a Controlled Trial (2016-2019) and its sister research study Pustular Psoriasis, Elucidating Underlying Mechanisms (2016-2020). A Northern European cohort including 193 patients was independently ascertained by the European Rare and Severe Psoriasis Expert Network (2014-2017). Patients had been recruited in secondary or tertiary dermatology referral centers. All patients were of European descent. The PPP diagnosis was established by dermatologists, based on clinical examination and/or published consensus criteria. The present study was conducted from October 1, 2014, to March 15, 2020. MAIN OUTCOMES AND MEASURES Demographic characteristics, comorbidities, smoking status, Palmoplantar Pustulosis Psoriasis Area Severity Index (PPPASI), measuring severity from 0 (no sign of disease) to 72 (very severe disease), or Physician Global Assessment (PGA), measuring severity as 0 (clear), 1 (almost clear), 2 (mild), 3 (moderate), and 4 (severe). RESULTS Among the 203 UK patients (43 men [21%], 160 women [79%]; median age at onset, 48 [interquartile range (IQR), 38-59] years), the PPPASI was inversely correlated with age of onset (r = −0.18, P = .01). Similarly, in the 159 Northern European patients who were eligible for inclusion in this analysis (25 men [16%], 134 women [84%]; median age at onset, 45 [IQR, 34-53.3] years), the median age at onset was lower in individuals with a moderate to severe PGA score (41 years [IQR, 30.5-52 years]) compared with those with a clear to mild PGA score (46.5 years [IQR, 35-55 years]) (P = .04). In the UK sample, the median PPPASI score was higher in women (9.6 [IQR, 3.0-16.2]) vs men (4.0 [IQR, 1.0-11.7]) (P = .01). Likewise, moderate to severe PPP was more prevalent among Northern European women (57 of 134 [43%]) compared with men (5 of 25 [20%]) (P = .03). In the UK cohort, the median PPPASI score was increased in current smokers (10.7 [IQR, 4.2-17.5]) compared with former smokers (7 [IQR, 2.0-14.4]) and nonsmokers (2.2 [IQR, 1-6]) (P = .003). Comparable differences were observed in the Northern European data set, as the prevalence of moderate to severe PPP was higher in former and current smokers (51 of 130 [39%]) compared with nonsmokers (6 of 24 [25%]) (P = .14). CONCLUSIONS AND RELEVANCE The findings of this study suggest that PPP severity is associated with early-onset disease, female sex, and smoking status. Thus, smoking cessation intervention might be beneficial.

Clinical characteristics, quality of life and risk factors for severity in palmoplantar pustulosis: a cross‐sectional, multicentre study of 263 patients

“…In the current study, the prevalence of a positive family history was 8.3% for PPP and slightly higher (9.5%) for PsV. A similar pattern of family history prevalence being lower for PPP and higher for PsV was reported in previous studies, with ranges of 0%–11% and 1.5%–32%, respectively 5,8–10,15,20 . These results support a shared genetic background between PPP and PsV.…”

“…This can be explained by the fact that both BMI and prevalence of obesity is considerably higher in Turkish women (30%) than in men (17%) in the general Turkish population 16 . We also aimed to identify whether there is an association between obesity and disease severity, as few studies have examined this association 3,9,17 . Consistent with two previous studies, 3,9 we found no association between higher PPPASI and either mean BMI or frequency of overweight/obesity.…”

“…We also investigated the factors associated with PPPASI, which is a rarely explored topic. Benzian‐Olsson et al 9 . recently reported that PPPASI was higher in patients with early‐onset disease, in women and in current smokers, whereas Trattner et al 3 .…”

Recent advances in palmoplantar pustulosis

“…In 2017, Trattner et al . in a cross-sectional study demonstrated a direct correlation between severity, measured by PalmoPlantar Pustulosis Severity Index (PPPASI), and QoL impairment, measured by Dermatology Life Quality Index (DLQI), data recently confirmed in a larger study including UK and Northern European patients 10 , 16 . PPP severity seems to be higher in female versus male patients and in current or past smokers 10 .…”

“…The prevalence of PV among PPP patients ranges from 14 to 61% 10 – 13 . Nail involvement (nail psoriasis) in PPP seems to be frequent, ranging from 30 to 76% 2 .…”