Original articlePalmoplantar psoriasis is associated with greater impairment of health-related quality of life compared 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)
- et al.
The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: results from NHANES 2003-2004
J Am Acad Dermatol
(2009) - et al.
Global epidemiology of psoriasis: a systematic review of incidence and prevalence
J Invest Dermatol
(2013) - et al.
The risk of stroke in patients with psoriasis
J Invest Dermatol
(2009) - et al.
Psoriasis causes as much disability as other major medical diseases
J Am Acad Dermatol
(1999) - et al.
Psychologic factors in psoriasis: consequences, mechanisms, and interventions
Dermatol Clin
(2005) - et al.
Quantifying the harmful effect of psoriasis on health-related quality of life
J Am Acad Dermatol
(2002) Population-based epidemiologic study of psoriasis with emphasis on quality of life assessment
Dermatol Clin
(1996)- et al.
Feelings of stigmatization in patients with psoriasis
J Am Acad Dermatol
(1989) - et al.
Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction
J Investig Dermatol Symp Proc
(2004) - et al.
Patients with palmoplantar psoriasis have more physical disability and discomfort than patients with other forms of psoriasis: implications for clinical practice
J Am Acad Dermatol
(2003)
Palmoplantar psoriasis: a phenotypical and clinical review with introduction of a new quality-of-life assessment tool
J Am Acad Dermatol
Palmoplantar psoriasis: experience with 8-methoxypsoralen soaks plus ultraviolet A with the use of a high-output metal halide device
J Am Acad Dermatol
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
Validity of the EQ-5D as a generic health outcome instrument in a heroin-dependent population
Drug Alcohol Depend
Genetic analysis of PSORS1 distinguishes guttate psoriasis and palmoplantar pustulosis
J Invest Dermatol
Psoriasis severity and the prevalence of major medical comorbidity: a population-based study
JAMA Dermatol
Risk of myocardial infarction in patients with psoriasis
JAMA
Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database
Eur Heart J
Psoriasis and the risk of diabetes mellitus: a systematic review and meta-analysis
JAMA Dermatol
Risk of moderate to advanced kidney disease in patients with psoriasis: population based cohort study
BMJ
Preference-based EQ-5D index scores for chronic conditions in the United States
Med Decis Making
The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey
Arch Dermatol
Quality of life and work productivity impairment among psoriasis patients: findings from the National Psoriasis Foundation survey data 2003-2011
PLoS One
Quality of life in patients with psoriasis
Health Qual Life Outcomes
Quality of life in patients with psoriasis: the contribution of clinical variables and psoriasis-specific stress
Br J Dermatol
The effect of severe psoriasis on the quality of life of 369 patients
Br J Dermatol
Rapid improvement of palmoplantar psoriasis after cessation of smoking
Sultan Qaboos Univ Med J
A retrospective analysis of treatment responses of palmoplantar psoriasis in 114 patients
J Eur Acad Dermatol Venereol
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2023, Journal of Investigative DermatologyCitation 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).
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.