Original article
Palmoplantar psoriasis is associated with greater impairment of health-related quality of life compared with moderate to severe plaque psoriasis

https://doi.org/10.1016/j.jaad.2014.04.063Get rights and content

Background

The impact of palmoplantar psoriasis on health-related quality of life (QoL) is largely unknown.

Objective

We sought to compare clinical characteristics and patient-reported outcomes between patients with palmoplantar psoriasis and moderate to severe plaque psoriasis.

Methods

We conducted a cross-sectional study of patients with plaque psoriasis (N = 1153) and palmoplantar psoriasis (N = 66) currently receiving systemic or light treatment for psoriasis.

Results

Patients with palmoplantar psoriasis were more likely to report Dermatology Life Quality Index scores that correspond to at least a moderate impact on QoL (odds ratio [OR] 2.08; 95% confidence interval [CI] 1.20-3.61); problems with mobility (OR 1.98; 95% CI 1.10-3.58), self-care (OR 3.12; 95% CI 1.24-7.86), and usual activities (OR 2.47; 95% CI 1.44-4.22) on the European Quality of Life-5 Dimensions questionnaire; and heavy topical prescription use of at least twice daily in the preceding week (OR 2.81; 95% CI 1.63-4.85) than those with plaque psoriasis.

Limitations

Our assessment tools may not account for all dimensions of health-related QoL affected by palmoplantar disease, and these results may not be generalizable to patients with milder forms of psoriasis.

Conclusion

Patients with palmoplantar psoriasis experience greater health-related QoL impairment and are more likely to report heavy use of topical prescriptions than those with moderate to severe plaque psoriasis.

Section snippets

Study design

We conducted a descriptive, cross-sectional study to determine the impact of plaque or palmoplantar psoriasis on patients' HRQoL and their use of prescription topical medications. Consecutive patients being seen by their dermatology providers for routine follow-up care were enrolled, and data were collected using dermatologist assessments and patient questionnaires.37 The study was approved by the institutional review board and was conducted in accordance with the Declaration of Helsinki.

Results

We included 1153 patients with plaque and 66 with palmoplantar psoriasis currently receiving systemic or light therapy in our study (Fig 1). Their demographic information and clinical characteristics are shown in Table I. Patients with palmoplantar psoriasis were older than patients with plaque psoriasis with mean ages (SD) of 53.8 years (12.6) versus 48.7 years (15.2) (P = .007) respectively, and were more likely to be female (75.8% vs 48%; P < .001) and to be current or past smokers

Discussion

We found that palmoplantar psoriasis is associated with substantial impairment of HRQoL. Specifically, compared with moderate to severe plaque psoriasis, palmoplantar psoriasis is independently associated with a greater impact on skin-related QoL; a greater impairment of mobility, self-care, and usual activities; and a greater dependency on topical medications. Notably, patients with palmoplantar psoriasis reported more difficulty with activities of daily living whereas no differences were

References (57)

  • E. Farley et al.

    Palmoplantar psoriasis: a phenotypical and clinical review with introduction of a new quality-of-life assessment tool

    J Am Acad Dermatol

    (2009)
  • W.R. Coleman et al.

    Palmoplantar psoriasis: experience with 8-methoxypsoralen soaks plus ultraviolet A with the use of a high-output metal halide device

    J Am Acad Dermatol

    (1989)
  • A. Robinson et al.

    Physician Global Assessment (PGA) and Psoriasis Area and Severity Index (PASI): why do both? A systematic analysis of randomized controlled trials of biologic agents for moderate to severe plaque psoriasis

    J Am Acad Dermatol

    (2012)
  • B.P. van der Zanden et al.

    Validity of the EQ-5D as a generic health outcome instrument in a heroin-dependent population

    Drug Alcohol Depend

    (2006)
  • K. Asumalahti et al.

    Genetic analysis of PSORS1 distinguishes guttate psoriasis and palmoplantar pustulosis

    J Invest Dermatol

    (2003)
  • H. Yeung et al.

    Psoriasis severity and the prevalence of major medical comorbidity: a population-based study

    JAMA Dermatol

    (2013)
  • J.M. Gelfand et al.

    Risk of myocardial infarction in patients with psoriasis

    JAMA

    (2006)
  • N.N. Mehta et al.

    Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database

    Eur Heart J

    (2010)
  • A.W. Armstrong et al.

    Psoriasis and the risk of diabetes mellitus: a systematic review and meta-analysis

    JAMA Dermatol

    (2013)
  • J. Wan et al.

    Risk of moderate to advanced kidney disease in patients with psoriasis: population based cohort study

    BMJ

    (2013)
  • P.W. Sullivan et al.

    Preference-based EQ-5D index scores for chronic conditions in the United States

    Med Decis Making

    (2006)
  • G. Krueger et al.

    The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey

    Arch Dermatol

    (2001)
  • A.W. Armstrong et al.

    Quality of life and work productivity impairment among psoriasis patients: findings from the National Psoriasis Foundation survey data 2003-2011

    PLoS One

    (2012)
  • M.J. Bhosle et al.

    Quality of life in patients with psoriasis

    Health Qual Life Outcomes

    (2006)
  • D.G. Fortune et al.

    Quality of life in patients with psoriasis: the contribution of clinical variables and psoriasis-specific stress

    Br J Dermatol

    (1997)
  • A.Y. Finlay et al.

    The effect of severe psoriasis on the quality of life of 369 patients

    Br J Dermatol

    (1995)
  • H.H. Elahmed

    Rapid improvement of palmoplantar psoriasis after cessation of smoking

    Sultan Qaboos Univ Med J

    (2013)
  • E. Adisen et al.

    A retrospective analysis of treatment responses of palmoplantar psoriasis in 114 patients

    J Eur Acad Dermatol Venereol

    (2009)
  • Cited by (78)

    • Comparison of the Inflammatory Circuits in Psoriasis Vulgaris, Non‒Pustular Palmoplantar Psoriasis, and Palmoplantar Pustular Psoriasis

      2023, Journal of Investigative Dermatology
      Citation Excerpt :

      Patients with NPPP have erythematous and squamous plaques of psoriasis on the palms and/or soles without the presence or history of pustules (Bissonnette et al., 2017). Although PPPP and NPPP lesions are localized, they have substantial and debilitating effects on QOL (Chung et al., 2014) and are highly refractory to current treatments. Although not approved, current treatments include topical corticosteroids, phototherapy, acitretin, apremilast, and cyclosporine (Gianfaldoni et al., 2017; Jin et al., 2019; Lee and Li, 2009; Sevrain et al., 2014; Ständer et al., 2020; Wilsmann-Theis et al., 2021); however, evidence for the efficacy of these treatments is lacking (Obeid et al., 2020).

    View all citing articles on Scopus

    This study was supported by grant RC1-AR058204 and K24-AR064310 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (Dr Gelfand), Dermatology Foundation Career Development Award (Dr Takeshita), T32-AR07465 from the National Institutes of Health (Mr Shin), and an unrestricted grant from Eli Lilly. The sponsors had no role in the design and conduct of the study, in the collection and management of the data, or in the preparation of the manuscript. An author from Eli Lilly participated in data analysis and interpretation, manuscript review, and decision to submit the manuscript. None of the other sponsors participated in data analysis/interpretation, review, or decision to submit the manuscript.

    Disclosure: Dr Callis Duffin was an investigator, consultant, and/or speaker for AbbVie, Amgen, ApoPharma, Bristol-Myers Squibb, Celgene, Eli Lilly, Genzyme, Incyte, Janssen Biotech, Novo Nordisk, Pfizer, and Wyeth, receiving honoraria and/or salary; served on the advisory board of Amgen; and received residency/fellowship program funding from AbbVie and Amgen. Dr Krueger served as a consultant for AbbVie, Amgen, and Janssen Biotech; had grants or has pending grants from AbbVie and Amgen; and received payment for lectures and travel-related expenses from AbbVie, Amgen, and Janssen Biotech. Dr Robertson is employed by the National Psoriasis Foundation, which receives unrestricted financial support from companies that make products used to treat psoriasis and psoriatic arthritis, including AbbVie, Amgen, Celgene, Eli Lilly, Galderma Laboratories LP, Janssen Biotech, Leo Pharma, Novartis, Pfizer, and Stiefel, a GSK company. Dr Robertson has also served as an uncompensated member of advisory boards at AbbVie and Merck. Dr Van Voorhees served on advisory boards for Amgen, AbbVie, Genentech, Warner Chilcott, Leo, and Janssen Biotech; served as an investigator for Amgen and AbbVie, receiving grants; and served as a consultant for Amgen. Ms Edson-Heredia is a full-time employee and stockholder of Eli Lilly. Dr Gelfand served as a consultant for AbbVie, Amgen, Eli Lilly, Merck, Janssen Biotech, Novartis, and Pfizer, receiving honoraria; had grants or has pending grants from AbbVie, Amgen, Genentech, Novartis, Eli Lilly, and Pfizer; and received payment for continuing medical education work related to psoriasis. Ms Chung, Drs Takeshita and Troxel, and Mr Shin have no conflicts of interest to declare.

    View full text