Association of clinical and demographic factors with the severity of palmoplantar pustulosis

Benzian-Olsson, N. et al. (2020) Association of clinical and demographic factors with the severity of palmoplantar pustulosis. JAMA Dermatology, 156(11), pp. 1216-1222. (doi: 10.1001/jamadermatol.2020.3275) (PMID:32936291) (PMCID:PMC7495329)

Abstract

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.

• Item Type: Articles
• Additional Information: Support for the study was received from the Department of Health via the NIHR BioResource Clinical Research Facility and comprehensive Biomedical Research Centre awards to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust (guysbrc-2012-1). Support was also received from the Newcastle NIHR Biomedical Research Centre. The APRICOT trial and the PLUM study were funded by the EME Programme, an MRC and NIHR partnership (grant EME 13/50/17 to Drs Smith, Capon, Barker, and Griffiths). This work was supported by the European Academy of Dermatology and Venereology (grant PPRC-2018-25 to Drs Barker, Capon, and Navarini, and grant PPRC-2012-11 to Drs Navarini and Barker). Ms Benzian-Olsson was funded by an NIHR predoctoral fellowship (grant NIHR300473). Dr Dand was funded by Health Data Research UK (MR/S003126/1). Dr Griffiths was funded in part by the NIHR Manchester Biomedical Research Centre and is an NIHR Emeritus Senior Investigator.
• Keywords: Dermatology
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Burden, Professor David
• Authors: Benzian-Olsson, N., Dand, N., Chaloner, C., Bata-Csorgo, Z., Borroni, R., Burden, A. D., Cooper, H. L., Cornelius, V., Cro, S., Dasandi, T., Griffiths, C. E. M., Kingo, K., Koks, S., Lachmann, H., McAteer, H., Meynell, F., Mrowietz, U., Parslew, R., Patel, P., Pink, A. E., Reynolds, N. J., Tanew, A., Torz, K., Trattner, H., Wahie, S., Warren, R. B., Wright, A., Barker, J. N., Navarini, A. A., Smith, C. H., and Capon, F.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Journal Name: JAMA Dermatology
• Publisher: American Medical Association
• ISSN: 2168-6068
• ISSN (Online): 2168-6084
• Published Online: 16 September 2020
• Copyright Holders: Copyright © 2020 Benzian-Olsson N et al.
• First Published: First published in JAMA Dermatology 156(11): 1216-1222
• Publisher Policy: Reproduced under a Creative Commons License