Palmoplantar pustulosis and acrodermatitis continua of Hallopeau: demographic and clinical comparative study in a large multicentre cohort

Abstract

Background Acral pustular disease within the pustular psoriasis/psoriasis‐like spectrum mainly includes palmoplantar pustulosis (PPP) and acrodermatitis continua of Hallopeau (ACH). Scarce data argue for a distinction between these two entities, but no study has compared the clinical and epidemiologic characteristics of ACH and PPP. Objectives We aimed to perform a comparative description of the epidemiological and clinical characteristics of PPP and ACH in a multicentre retrospective cohort. Methods In this multicentre national retrospective cohort study, we compared the epidemiological characteristics, comorbidities and psoriasis characteristics of patients with PPP and ACH. Results A total of 234 patients were included: 203 (87%) with PPP, 18 (8%) with ACH and 13 (6%) with both, according to 2017 ERASPEN criteria. As compared with ACH, PPP was associated with female sex, smoking activity and higher median BMI (P = 0.01, P = 0.02 and P = 0.05 respectively). A family background of psoriasis was more frequent in PPP than ACH. Age of onset of palmoplantar disease was similar between PPP and ACH patients, median age 44 and 48 years respectively. Peripheral joint inflammatory involvement was the only rheumatic disease associated with ACH. The association with another psoriasis type was similar in PPP and ACH (57.6% and 61.1% respectively). Conclusion Our study confirms in a large PPP cohort the predominance of females and a high prevalence of smoking and elevated body mass index but also shows an association of these features in PPP as compared with ACH. In addition, it highlights peripheral arthritis as the only arthritis endotype associated with ACH. Increased knowledge of the immunogenetic backgrounds underlying these two entities is warranted to better stratify pustular psoriasis or psoriasis‐like entities for precision medicine.

Clinical Characteristics of Patients with Pustular Psoriasis: A Single-Center Retrospective Observational Study

“…This finding is interesting considering that there are few data in the literature on the matter and is consistent with the finding of Ohata C et al in Japanese patients with GPP (24 out of 102, i.e., 23%) [ 16 ]. Of note, the anatomical proximity between the nail apparatus and distal interphalangeal joints supports such an association in ACH [ 6 ]. We found a higher prevalence of tobacco smoking in patients with PPP, reaching a prevalence of 70%, as expected [ 6 ].…”

“…Of note, the anatomical proximity between the nail apparatus and distal interphalangeal joints supports such an association in ACH [ 6 ]. We found a higher prevalence of tobacco smoking in patients with PPP, reaching a prevalence of 70%, as expected [ 6 ]. Local and systemic exposure to smoke may trigger pustular psoriasis in patients with a predisposed background through the excretion of stress-induced cytokines in keratinocytes as a Koebner phenomenon [ 14 ].…”

“…Few epidemiological studies have been conducted on pustular psoriasis, mostly focused on GPP and in Japan, whereas epidemiologic data in European countries are rarer [ 6 ]. The aim of this study was to investigate the phenotypes of pustular psoriasis and the patients’ characteristics observed in a real-life setting.…”

Acrodermatitis continua of Hallopeau and generalised pustular psoriasis: Should they be the same or different entities?

“…3,48 Psoriatic arthritis occurs in 20.5%-36.4% of patients with ACH. 3,48,49 From our review (Table 1), the frequency of concomitant plaque psoriasis in patients with ACH (6.5%-46.2%) 3,45,48,49 appears lower than that of patients with GPP (31.3%-78%). 8,10,43,44…”

Acrodermatitis continua of Hallopeau with psoriatic arthritis treated with biologics and apremilast

“…4,5 A recent multicenter cohort study showed that peripheral arthritis was observed in 27.8% (5/18) of ACH patients, although the presence of dactylitis was not mentioned. 6 To the best of our knowledge, dactylitis has never been reported in association with ACH, and our case suggests that ACH is one of the diseases that present with dactylitis.…”