Insulin resistance, diabetes mellitus and thyroid dysfunction in patients with palmoplantar pustulosis: a case-controlled study

Abstract

IntroductionPalmoplantar pustulosis (PPP) is a chronic pustular inflammatory skin disease; however, its pathogenesis is not well understood. Several factors, such as genetics, tobacco use and autoimmune issues, may contribute to this disease.AimThis research was conducted to investigate the relationships between insulin resistance, thyroid disease and PPP.Material and methodsThirty-three patients with PPP and 27 age- and gender-matched controls were analysed for their smoking histories, thyroid function tests, anti-thyroid peroxidase antibody (anti-TPO) levels, fasting glucose, fasting insulin levels and the homeostatic model assessment (HOMA) index for insulin resistance.ResultsWe found significant differences between the PPP and control groups according to their tobacco use and anti-TPO levels (p = 0.009 and p = 0.009, respectively). The proportion of tobacco use was 90% in the PPP patients and 63% in the controls. Gender and tobacco use were predictive risk factors for PPP in the multivariate analysis (OR = 141.7, p < 0.0001 and OR = 147.6, p = 0.006, respectively). An anti-TPO level > 35 U/ml and the presence of a thyroid abnormality were independent risk factors in the univariate, but not the multivariate analysis (OR = 4.2, p = 0.025 and OR = 5.4, p = 0.004, respectively). A moderate correlation between the gender and anti-TPO level was found (r = 0.361, p = 0.039); however, the fasting glucose, insulin and HOMA index were not significant between the PPP and control groups.ConclusionsFemale gender and smoking were the most important risk factors for PPP; however, the increase in the anti-TPO level may be related to the predominance of females afflicted with this disease. Additional studies are necessary to clarify the relationships between PPP, thyroid disease and diabetes mellitus.

Palmoplantar Pustulosis: Recent Advances in Etiopathogenesis and Emerging Treatments

“…In many studies, T2DM was observed in 7.7-19% of patients [2,7,9,25]. However, Ataş and Gönül [24] showed no significant difference between the fasting glucose, insulin, and homeostatic model assessment between a group with PPP and controls. The incidence of hyperlipidemia in patients with PPP ranges from 10.2-49% in different populations [2,5,25,26] and is a risk factor for ischemic heart disease and hypertension.…”

Palmoplantar Pustulosis: A Systematic Review of Risk Factors and Therapies

“…Female sex is a predictive risk factor with an 8.8-fold higher risk for PPP (OR 141.7, p<0.0001). 16 , 18 Smoking is another risk factor with a 32.7-fold increased risk for the development of PPP (OR 147.6, p=0.006). 7 , 16 , 18 , 19 Smokers were 43–95.23% of the cohorts, and higher package-years and a longer period of smoking were associated with higher risk.…”

“… 16 , 18 Smoking is another risk factor with a 32.7-fold increased risk for the development of PPP (OR 147.6, p=0.006). 7 , 16 , 18 , 19 Smokers were 43–95.23% of the cohorts, and higher package-years and a longer period of smoking were associated with higher risk. 7 , 16 , 18 , 19 Smokers were significantly more prevalent in the PPP cohort than the PV cohort.…”

Refractory Palmoplantar Pustulosis Successfully Treated with JAK Inhibitor Tofacitinib: A Case Series

“…Autoimmune thyroid disease is often observed in PPP patients. 7 Obesity (BMI > 25 mg/m2), T2DM, hyperlipidemia, allergic diseases (such as asthma, atopic dermatitis, and rhinitis allergica) and joint pain frequently accompanies PPP lesions. 7,8 PPP is challenging to treat and usually requires prolonged management.…”

“…7 Obesity (BMI > 25 mg/m2), T2DM, hyperlipidemia, allergic diseases (such as asthma, atopic dermatitis, and rhinitis allergica) and joint pain frequently accompanies PPP lesions. 7,8 PPP is challenging to treat and usually requires prolonged management. Therapy resistance and frequent relapse discourage patients from follow-up.…”