Journal article
Association of Clinical and Demographic Factors With the Severity of Palmoplantar Pustulosis.
- Benzian-Olsson N Department of Medical and Molecular Genetics, King's College London, London, United Kingdom.
- Dand N Department of Medical and Molecular Genetics, King's College London, London, United Kingdom.
- Chaloner C Department of Medical and Molecular Genetics, King's College London, London, United Kingdom.
- Bata-Csorgo Z Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.
- Borroni R Humanitas Clinical and Research Center, IRCCS, Milan, Italy.
- Burden AD Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom.
- Cooper HL Portsmouth Dermatology Unit, Portsmouth Hospitals Trust, Portsmouth, United Kingdom.
- Cornelius V Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom.
- Cro S Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom.
- Dasandi T St John's Institute of Dermatology, King's College London, London, United Kingdom.
- Griffiths CEM Dermatology Centre, National Institute for Health Research Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom.
- Kingo K Dermatology Clinic, Tartu University Hospital, Department of Dermatology, University of Tartu, Tartu, Estonia.
- Koks S Centre for Molecular Medicine and Innovative Therapeutics, Murdoch and Perron Institute for Neurological and Translational Science, Murdoch University, Nedlands, Western Australia, Australia.
- Lachmann H National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom.
- McAteer H The Psoriasis Association, Northampton, United Kingdom.
- Meynell F St John's Institute of Dermatology, King's College London, London, United Kingdom.
- Mrowietz U Psoriasis Center at the Department of Dermatology, University Medical Center, Schleswig-Holstein, Campus Kiel, Kiel, Germany.
- Parslew R Department of Dermatology, Royal Liverpool Hospitals, Liverpool, United Kingdom.
- Patel P St John's Institute of Dermatology, King's College London, London, United Kingdom.
- Pink AE St John's Institute of Dermatology, King's College London, London, United Kingdom.
- Reynolds NJ Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
- Tanew A Department of Dermatology, Medical University of Vienna, Austria.
- Torz K Psoriasis Center at the Department of Dermatology, University Medical Center, Schleswig-Holstein, Campus Kiel, Kiel, Germany.
- Trattner H Department of Dermatology, Medical University of Vienna, Austria.
- Wahie S Department of Dermatology, University Hospital of North Durham, Durham.
- Warren RB The Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
- Wright A Department of Dermatology, St Lukes Hospital, Bradford, United Kingdom.
- Barker JN St John's Institute of Dermatology, King's College London, London, United Kingdom.
- Navarini AA Department of Dermatology & Allergy, University Hospital of Basel, Basel, Switzerland.
- Smith CH St John's Institute of Dermatology, King's College London, London, United Kingdom.
- Capon F Department of Medical and Molecular Genetics, King's College London, London, United Kingdom.
- 2020-09-16
Published in:
- JAMA dermatology. - 2020
English
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.
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.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1001/jamadermatol.2020.3275
- PMID 32936291
- Persistent URL
- https://folia.unifr.ch/global/documents/109711
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