Characteristics and prevalence of plaque psoriasis in patients with palmoplantar pustulosis

Abstract

Summary Background Palmoplantar pustulosis (PPP) is a chronic pustular skin condition on the palms and soles. The disease is often seen in combination with plaque psoriasis, and whether PPP is a variant of psoriasis has been debated. The disease prevalence of PPP and co‐occurring psoriasis is not yet established and the patient group remains understudied. Objectives To estimate the prevalence of PPP and co‐occurring psoriasis in three population‐based cohorts and to provide information on patient demographics and characteristics. Methods Administrative healthcare registries and insurance databases from the U.S.A., Denmark and Germany were used as data sources. Patients with PPP were defined by a single International Classification of Diseases 10th Revision code for PPP during a 1‐year period. Information regarding co‐occurring plaque psoriasis and other comorbidities was extracted. Furthermore, use of antipsoriatic medication was identified. Results In total 1435, 751 and 1832 patients with PPP were identified in the U.S., Danish and German populations, with estimated 1‐year prevalences of 0·009%, 0·005% and 0·08%, respectively. Plaque psoriasis was present in 14·2–61·3% of patients with PPP. Patients with co‐occurring psoriasis had an overall higher prevalence of psoriatic arthritis. Similarly, medication use was more prevalent in patients with PPP with co‐occurring psoriasis, and especially pronounced was the use of biologic therapies. Conclusions This large observational study on patients with PPP provides detailed information regarding patient demographics, comorbidities and medication use. The 1‐year prevalence of PPP varied in the three studied populations, possibly due to differences in diagnostics and recording practices. Psoriasis frequently co‐occurred in patients with PPP. What's already known about this topic? Palmoplantar pustulosis (PPP) is a skin disease of the palms of the hands and soles of the feet and is known to be related to psoriasis. Whether PPP is a distinct disease or a variant of psoriasis is not yet established. The condition is understudied in terms of disease prevalence, disease predictors, patient characteristics and comorbidity. What does this study add? In this study using data from three large population‐based cohorts we found low prevalence rates (< 0·1%) of PPP. The prevalence of psoriasis was estimated at between 14·2% and 61·3% in patients with psoriasis. Patients with PPP with co‐occurring psoriasis have a higher prevalence of psoriatic arthritis and use of antipsoriatic drugs.

Treatment Patterns in Danish Patients with Atopic Dermatitis Before and After Hospital Referral

“…Notably, the AD diagnosis has been validated in children and adults with very high positive Columns may not sum to exactly 100% because of multiple therapy use predictive values in the Danish registries, thus ensuring that patients indeed had AD at the time of their referral [12]. A novel finding, however, is the somewhat low use of potent TCS, which could either be a sign of general undertreatment across therapies or due to steroid-phobia among patients [24]. Nonetheless, the low use of established AD therapies is in stark contrast to the high symptom burden and need for disease resolution that is reported among patients with AD [6,22].…”

Prevalence and incidence of palmoplantar pustulosis in Sweden: a population‐based register study*

“…We found three national population‐based studies, based on claims data, estimating the annual prevalence of PPP, showing prevalence in Germany (2005), 15 Japan (2010–11) 7 and Korea (2015) 16 of 90, 120 and 52 cases per 100 000, respectively. In a recent multinational study, the annual PPP prevalences in the USA (2015–16), Denmark (2015–16) and Germany (2014) were estimated to be 9, 5 and 80 cases per 100 000, respectively 1 . Healthcare insurance claims data (USA and Germany) and data from the Danish NPR were used.…”

“…Traditionally PPP has been classified as a subgroup of psoriasis, as it is often seen in combination with psoriasis vulgaris. 1,2 Smoking, infection and certain drugs trigger or exacerbate the disease. 3 Many people who have PPP experience reduced quality of life, and one study reported that PPP is associated with greater impairment of quality of life than moderate-to-severe psoriasis.…”

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

“…First, whether PPP represents a psoriasis variant remains a point of debate, 1,22–24 resulting in differences in the diagnosis of extrapalmoplantar lesions 3,19,25 . Second, among studies using registry data, the International Classification of Diseases codes used for PPP and PsV may differ or be missing 21,22 . Differences in data sources (from insurance data/free healthcare services) used by PPP studies might also influence the results 21 .…”