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Takahara M, Doi A, Inoshita A, Ohori J, Kono M, Hirano A, Kakuki T, Yamada K, Akagi H, Takano K, Nakata S, Harabuchi Y. Guidance of clinical management for patients with tonsillar focal disease. Auris Nasus Larynx 2024; 51:761-773. [PMID: 38875993 DOI: 10.1016/j.anl.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/16/2024]
Abstract
Tonsillar focal diseases (TFDs) are defined as "diseases caused by organic and/or functional damage in organs distant from tonsil, and the disease outcome is improved by tonsillectomy." Although several reports and reviews have shown the efficacy of tonsillectomy for TFDs, no guidelines for the clinical management of the diagnosis and treatment of TFDs have been reported. Therefore, the Society of Stomato-pharyngology established a committee to guide the clinical management of patients with TFDs, and the original guide was published in May 2023. This article summarizes the English version of the manuscript. We hope that the concept of TFDs will spread worldwide, and that one as many patients with TFDs will benefit from tonsillectomy.
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Affiliation(s)
- Miki Takahara
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Midorigaoka higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Akira Doi
- Division of Otolaryngology, Kochi Health Sciences Center
| | - Ayako Inoshita
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Junichiro Ohori
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Masamitsu Kono
- Department of Otorhinolaryngology-Head and Neck Surgery, Wakayama Medical University, 911-1 Kimiidera, Wakayama-shi, 641-8509, Japan
| | - Ai Hirano
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Takuya Kakuki
- Department of Otolaryngology-Head and Neck Surgery, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Kentaro Yamada
- Department of Otorhinolaryngology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | | | - Kenichi Takano
- Department of Otolaryngology-Head and Neck Surgery, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Seiichi Nakata
- Department of Otorhinolaryngology, Fujita Health University Bantane Hospital, 3-6-10 Otohashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Yasuaki Harabuchi
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Midorigaoka higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
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Ramcharran D, Strober B, Gordon K, DeKlotz C, Fakharzadeh S, Yang YW, Swerdel J, Hardin J, Dronavalli S, Paller AS. The Epidemiology of Palmoplantar Pustulosis: An Analysis of Multiple Health Insurance Claims and Electronic Health Records Databases. Adv Ther 2023; 40:5090-5101. [PMID: 37737889 PMCID: PMC10567878 DOI: 10.1007/s12325-023-02669-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a chronic inflammatory condition characterized by sterile pustules on the palms and soles. This study evaluated the epidemiology of PPP using claims and electronic health record (EHR) databases. METHODS Patients coded for PPP in the United States (US) and Japan from 2016 to 2020 were identified. Several PPP definitions were evaluated; the specific definition (≥ 2 visits coded for PPP, the second 31-730 days after diagnosis) was chosen for characterizing PPP epidemiology. Baseline characteristics and pre- and post-diagnosis treatments were summarized. Prevalence and incidence rates were analyzed by calendar year, sex, age, and database. RESULTS Prevalence and incidence of PPP were higher in Japan than the US. PPP prevalence increased over time. PPP occurred predominantly in adulthood and was more common among women. Features of metabolic syndromes, anxiety, and depression were more common among US PPP patients. Consistently high baseline use of anti-bacterial, anti-inflammatory/anti-rheumatic, and obstructive airway disease treatments was observed among PPP patients. Potential miscoding or misclassification of PPP limited this analysis. Prevalence estimates from databases may differ from field- and population-based approaches. CONCLUSIONS The burden of PPP was greater in Japan than in the US. Additional studies are needed to further elucidate PPP epidemiology worldwide.
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Affiliation(s)
- Darmendra Ramcharran
- Global Research and Development Epidemiology, Janssen Pharmaceutical Companies of Johnson and Johnson, Titusville, NJ, USA
- Safety and Quantitative Innovation, GSK, Waltham, MA, USA
| | - Bruce Strober
- Yale University, New Haven, CT, USA
- Central Connecticut Dermatology, Cromwell, CT, USA
| | | | - Cynthia DeKlotz
- Immunology Research and Development, Janssen Pharmaceutical Companies of Johnson and Johnson, Springhouse, PA, USA
| | - Steven Fakharzadeh
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, Horsham, PA, USA
| | - Ya-Wen Yang
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, Horsham, PA, USA
| | - Joel Swerdel
- Janssen Research and Development, Titusville, NJ, USA
| | - Jill Hardin
- Janssen Research and Development, Titusville, NJ, USA
| | | | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine and the Ann and Robert H Lurie Children's Hospital, 676 N. St. Clair, Suite 1600, Chicago, IL, 60611-2997, USA.
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Hattori K, Takahashi N, Suzuki M, Kojima T, Imagama S. A case of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome with isolated lesions of the thoracic spine. Mod Rheumatol Case Rep 2023; 7:243-246. [PMID: 35349712 DOI: 10.1093/mrcr/rxac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/01/2022] [Accepted: 03/25/2022] [Indexed: 01/07/2023]
Abstract
We report a case of isolated lesions of the thoracic spine attributed to synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. A 55-year-old woman who suffered from 6 months of back pain had vertebral osteomyelitis on magnetic resonance imaging (MRI). There were no laboratory findings suggestive of infection, malignancy, or autoimmune disease. Radiography, computed tomography (CT), and MRI of the thoracic spine showed mixed lesions of sclerosis and erosion, whereas bone scintigraphy did not show accumulation at any site except the thoracic spine. No lesions in the anterior chest wall or sacroiliac joints were apparent from CT and MRI. No lesions other than at the thoracic spine were observed. As the isolated lesions of the thoracic spine were considered not to have resulted from infection, malignancy, or autoimmune disease, the patient was referred to our department for differential diagnosis. Given that isolated sterile hyperostosis/osteitis among adults is included in the modified diagnostic criteria for SAPHO syndrome, we suspected that the mixed lesions of sclerosis and erosion of the thoracic spine in this case may reflect SAPHO syndrome with chronic non-bacterial osteitis (CNO) of the thoracic spine. Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) was initiated and led to alleviation of her back pain, although the thoracic spine lesions remained on the 6-month MRI. Based on the CNO of the thoracic spine and the rapid response to NSAIDs, the final diagnosis was SAPHO syndrome with isolated lesions of the thoracic spine.
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Affiliation(s)
- Kyosuke Hattori
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Nobunori Takahashi
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Mochihito Suzuki
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toshihisa Kojima
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shiro Imagama
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Zheng R, Ito YM, Yunoki M, Minoda K, Nobeyama S. Design and implementation of an adaptive confirmatory trial in Japanese patients with palmoplantar pustulosis. Contemp Clin Trials Commun 2022; 28:100935. [PMID: 35711679 PMCID: PMC9192787 DOI: 10.1016/j.conctc.2022.100935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/08/2022] [Accepted: 05/25/2022] [Indexed: 10/31/2022] Open
Abstract
Background/Aims Methods Results Conclusion
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Iwaki Y, Shibata S, Hu C. Pharmacokinetic/Pharmacodynamic Analysis of Guselkumab for Treatment of Palmoplantar Pustulosis: Clinical Implications of Guselkumab Dose, Disease Severity and Smoking in Japanese Patients. J Clin Pharmacol 2021; 62:182-189. [PMID: 34382209 DOI: 10.1002/jcph.1953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/06/2021] [Indexed: 11/09/2022]
Abstract
Guselkumab is a human IgG1λ monoclonal antibody that has been approved for treatment of multiple immunological diseases including palmoplantar pustulosis (PPP) in Japan. The efficacy of guselkumab in reducing disease severity as compared with placebo has been demonstrated in phase 2 and 3 clinical studies. In some patients assigned to the placebo treatment, worsening of PPP Area and Severity Index (PPPASI) score was noted. Most of these patients were smokers, raising a possibility of an association of smoking with the disease progression. To understand the clinical implications of guselkumab dose, baseline disease severity and smoking on the treatment effect and describe the longitudinal relationship between guselkumab exposure and the PPPASI score, a PK/PD modeling analysis was conducted using the pooled data from one phase 2 and one phase 3 study. Data from 207 Japanese patients (77% women and 60% smokers) with a median PPPASI score of 24.6 were included in the analysis. The observed treatment efficacy (the PPPASI score reduction) appeared to be similar at the current approved dose (100) mg and the higher dose (200 mg). Greater extent of the PPPASI score reduction (in absolute points) is expected in patients with higher baseline PPPASI score (severe disease). However, the higher baseline did not translate to larger magnitude of the change from baseline (in percentage) in the PPPASI score. Incorporating a linear disease progression effect in the model significantly decreased the NONMEM objective function value (p<0.001). Smoking status appeared tobe related to disease worsening in some patients, but the covariate did not reach statistical significance in the model. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yuki Iwaki
- Clinical Pharmacology and Pharmacometrics, Janssen Pharmaceutical K.K. Chiyoda-ku, Tokyo, Japan
| | - Sayori Shibata
- Clinical Pharmacology and Pharmacometrics, Janssen Pharmaceutical K.K. Chiyoda-ku, Tokyo, Japan
| | - Chuanpu Hu
- Clinical Pharmacology and Pharmacometrics, Janssen Research & Development, LLC, Spring House, PA, 19477, USA
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Sarıkaya Solak S, Kara Polat A, Kilic S, Oguz Topal I, Saricaoglu H, Karadag AS, Canpolat F, Kartal SP, Deveci BN, Kacar N, Polat Ekinci A, Guner R, Polat M, Dogan G, Guler Ozden M, Bulbul Baskan E, Ozaydin Yavuz G, Adisen E, Gulekon A, Tanribilir ME, Yilmaz O, Akman Karakas A, Ozturk P, Didar Balci D, Gonulal M, Yondem H, Turel Ermertcan A, Sendur N, Topyildiz H, Korkmaz S, Alpsoy E. Clinical characteristics, quality of life and risk factors for severity in palmoplantar pustulosis: a cross-sectional, multicentre study of 263 patients. Clin Exp Dermatol 2021; 47:63-71. [PMID: 34236713 DOI: 10.1111/ced.14829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a rare, chronic, inflammatory skin disease characterized by sterile pustules on palmar or plantar areas. Data on PPP are scarce. AIM To investigate the clinical characteristics and risk factors for disease severity in a large cohort of Turkish patients with PPP. METHODS We conducted a cross-sectional, multicentre study of patients with PPP recruited from 21 tertiary centres across Turkey. RESULTS In total, 263 patients (165 women, 98 men) were evaluated. Most patients (75.6%) were former or current smokers. The mean Palmoplantar Pustulosis Area and Severity Index (PPPASI) was 8.70 ± 8.06 and the mean Dermatology Life Quality Index (DLQI) score was 6.87 ± 6.08, and these scores were significantly correlated (r = 0.52, P < 0.001). Regression analysis showed that current smoking was significantly associated with increased PPPASI (P = 0.03). Coexisting psoriasis vulgaris (PsV) was reported by 70 (26.6%) patients. Male sex prevalence, PPP onset incidence, disease duration, DLQI, and prevalence of nail involvement and psoriatic arthritis (PsA) were significantly increased among patients with PPP with PsV. Of the 263 patients, 18 (6.8%) had paradoxical PPP induced by biologic therapy, and these patients had significantly increased mean DLQI and prevalence of PsA (r = 0.03, P = 0.001). CONCLUSION Our data suggest that smoking is a risk factor for both PPP development and disease severity. Patients with PPP with PsV present distinct clinical features and patients with biologic therapy-induced paradoxical PPP have reduced quality of life and are more likely to have PsA.
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Affiliation(s)
- S Sarıkaya Solak
- Departments of Dermatology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - A Kara Polat
- Medical Biostatistics, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - S Kilic
- Department of Dermatology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - I Oguz Topal
- Department of Dermatology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - H Saricaoglu
- Department of Dermatology, Prof Dr Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - A S Karadag
- Department of Dermatology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - F Canpolat
- Department of Dermatology, Memorial Atasehir Hospital, Istanbul, Turkey
| | - S P Kartal
- Department of Dermatology, Memorial Atasehir Hospital, Istanbul, Turkey
| | - B N Deveci
- Department of Dermatology, Memorial Atasehir Hospital, Istanbul, Turkey
| | - N Kacar
- Department of Dermatology, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - A Polat Ekinci
- Department of Dermatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - R Guner
- Department of Dermatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M Polat
- Department of Dermatology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| | - G Dogan
- Department of Dermatology, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - M Guler Ozden
- Department of Dermatology, Faculty of Medicine, Mugla, Mugla Sitki Kocman University, Mugla, Turkey
| | - E Bulbul Baskan
- Department of Dermatology, Prof Dr Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - G Ozaydin Yavuz
- Department of Dermatology, Faculty of Medicine, Samsun Ondokuz Mayis University, Samsun, Turkey
| | - E Adisen
- Department of Dermatology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - A Gulekon
- Department of Dermatology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - M E Tanribilir
- Department of Dermatology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - O Yilmaz
- Department of Dermatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - A Akman Karakas
- Department of Dermatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - P Ozturk
- Department of Dermatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - D Didar Balci
- Department of Dermatology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - M Gonulal
- Department of Dermatology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - H Yondem
- Departments of Dermatology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - A Turel Ermertcan
- Department of Dermatology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - N Sendur
- Department of Dermatology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - H Topyildiz
- Department of Dermatology, Medicana International Hospital, Izmir, Turkey
| | - S Korkmaz
- Department of Dermatology, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
| | - E Alpsoy
- Department of Dermatology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Yamamoto T. Guselkumab for the Treatment of Palmoplantar Pustulosis: A Japanese Perspective. Clin Pharmacol 2021; 13:135-143. [PMID: 34188558 PMCID: PMC8236264 DOI: 10.2147/cpaa.s266223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/11/2021] [Indexed: 11/28/2022] Open
Abstract
Palmoplantar pustulosis (PPP) is a chronic inflammatory disorder characterized by sterile pustules predominantly involving the palms and soles. PPP is refractory to various therapies such as topical ointment, oral medicine, and phototherapies. Pustulotic arthro-osteitis (PAO) is a major comorbidity of PPP that severely impairs patients’ quality of life. Recently, guselkumab, a monoclonal antibody against IL-23, has been available for the treatment of PPP in Japan. The purpose of the present review is to describe the characteristics of Japanese PPP patients and biologic therapy of PPP/PAO using guselkumab. Most Japanese dermatologists consider PPP as a distinct entity and co-existence of PPP and psoriasis is rare. However, outside Japan, PPP is often considered to be palmoplantar psoriasis, and extra-palmoplantar lesions associated with PPP are regarded as psoriasis. PPP develops or exacerbates either with or without arthralgia, following focal infections, such as tonsillitis, odontogenic infection, and sinusitis. Treatment of focal infection results in dramatic effects on cutaneous lesions as well as joint pain. By contrast, we sometimes see patients whose skin/joint symptoms do not improve after treatment of focal infection, whose focus of infection cannot be identified even in a detailed examination, and/or who refuse tonsillectomy even if strongly recommended. Such cases are considered to be indications of biologics. In this review, clinical features, pathophysiology and guselkumab therapy are discussed.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, 960-1295, Japan
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Kobayashi K, Kamekura R, Kato J, Kamiya S, Kamiya T, Takano K, Ichimiya S, Uhara H. Cigarette Smoke Underlies the Pathogenesis of Palmoplantar Pustulosis via an IL-17A-Induced Production of IL-36γ in Tonsillar Epithelial Cells. J Invest Dermatol 2021; 141:1533-1541.e4. [PMID: 33188781 DOI: 10.1016/j.jid.2020.09.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/24/2020] [Accepted: 09/09/2020] [Indexed: 02/08/2023]
Abstract
Palmoplantar pustulosis (PPP) is characterized by sterile pustules on the palms and soles. A strong association between PPP and tobacco smoking has been reported, and it has been speculated that the IL-17A pathway may play an important role in PPP. Recent studies have suggested that IL-36 plays a pivotal role in the pathogenesis of psoriasis and its subtypes. The relationships among IL-36, smoking, and PPP have not been examined. Here, we investigated the relationships among the smoking index, severity of the clinical condition of PPP, and in vitro dynamics of IL-36 in human tonsillar epithelial cells under the condition of exposure to a cigarette smoke extract. The results demonstrated that the Palmoplantar Pustulosis Area and Severity Index was strongly and positively correlated with the smoking index in female patients. Immunohistochemical examinations showed that IL-36γ was highly expressed in tonsillar epithelial cells from patients with PPP but not in those from patients with recurrent tonsillitis without PPP. The in vitro study revealed that IL-17A synergistically induced a release of IL-36γ under cigarette smoke extract exposure. These results suggest that local production of IL-36γ by epithelial cells induced by cigarette smoke exposure plays an important role in the pathogenesis of PPP.
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Affiliation(s)
- Keiju Kobayashi
- Department of Dermatology, School of Medicine, Sapporo Medical University, Sapporo, Japan; Department of Human Immunology, Research Institute for Frontier Medicine, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Ryuta Kamekura
- Department of Human Immunology, Research Institute for Frontier Medicine, School of Medicine, Sapporo Medical University, Sapporo, Japan; Department of Otolaryngology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Junji Kato
- Department of Dermatology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Shiori Kamiya
- Department of Dermatology, School of Medicine, Sapporo Medical University, Sapporo, Japan; Department of Human Immunology, Research Institute for Frontier Medicine, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Takafumi Kamiya
- Department of Dermatology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Kenichi Takano
- Department of Otolaryngology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Shingo Ichimiya
- Department of Human Immunology, Research Institute for Frontier Medicine, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Hisashi Uhara
- Department of Dermatology, School of Medicine, Sapporo Medical University, Sapporo, Japan.
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SnapshotDx Quiz: May 2021. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Yamamoto T. Similarity and difference between palmoplantar pustulosis and pustular psoriasis. J Dermatol 2021; 48:750-760. [PMID: 33650702 DOI: 10.1111/1346-8138.15826] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/07/2021] [Indexed: 12/11/2022]
Abstract
Palmoplantar pustulosis is a chronic inflammatory disorder characterized by sterile pustules predominantly involving the palms and soles. Palmoplantar pustulosis has many similar aspects to psoriasis, either plaque and pustular type, namely familial occurrence between palmoplantar pustulosis and psoriasis, the appearance of the Köbner phenomenon, joint involvement, and nail involvement. Pustular psoriasis is classified into generalized and localized types, and there are a number of papers regarding palmoplantar pustulosis as an acral variant of localized pustular psoriasis. Many Japanese dermatologists consider palmoplantar pustulosis to be a distinct entity from pustular psoriasis, and the coexistence of palmoplantar pustulosis and psoriasis is rare. However, outside Japan, palmoplantar pustulosis is often considered to be palmoplantar psoriasis or palmoplantar pustular psoriasis, and extra-palmoplantar lesions are also considered to be psoriasis. The purpose of the current review is to compare the similarities and differences between palmoplantar pustulosis and generalized/localized pustular psoriasis. Japanese patients with palmoplantar pustulosis have a close relationship with focal infection, and the associated bone-joint manifestation exclusively involves the anterior chest wall. Furthermore, pediatric occurrence of palmoplantar pustulosis is extremely rare, and difference of genetic background between palmoplantar pustulosis and psoriasis has also been reported. Treatment of focal infection often results in dramatic effects on both cutaneous lesions and joint pain of palmoplantar pustulosis. Those findings suggest that palmoplantar pustulosis should be separately considered from either palmoplantar psoriasis or palmoplantar pustular psoriasis. The clinicopathological features and therapeutic approach of both diseases are discussed.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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Kato N, Takama H, Ando Y, Yanagishita T, Ohshima Y, Ohashi W, Akiyama M, Watanabe D. Immediate response to apremilast in patients with palmoplantar pustulosis: a retrospective pilot study. Int J Dermatol 2021; 60:570-578. [PMID: 33454961 PMCID: PMC8248100 DOI: 10.1111/ijd.15382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/22/2020] [Accepted: 11/30/2020] [Indexed: 01/17/2023]
Abstract
Background Recent case reports have shown the efficacy of apremilast for the treatment of palmoplantar pustulosis (PPP). However, no study has statistically analyzed the clinical efficacy of oral apremilast in patients with PPP. Objectives To evaluate the effectiveness of apremilast, a phosphodiesterase 4 inhibitor, for PPP. Materials and Methods Among 13 patients who were diagnosed with PPP, 10 patients with PPP with either palmoplantar pustules (>1 mm diameter) or sternoclavicular joint pain were retrospectively analyzed. Results Palmoplantar Pustulosis Area and Severity Index (mean ± SD: baseline, 13.4 ± 9.5 vs. after treatment, 5.1 ± 5.6; P = 0.013) and the number of pustules measuring > 1 mm in diameter (3.9 ± 3.9 vs. 1.3 ± 1.9; P = 0.029) significantly improved in 2 (±1) weeks. Moreover, the Dermatology Life Quality Index (9.7 ± 7.0 vs. 3.3 ± 3.6; P = 0.009) and palmoplantar itching (visual analog scale [VAS] score) (5.6 ± 3.5 vs. 2.1 ± 2.2; P = 0.026) significantly improved in 2 weeks, whereas VAS scores of palmoplantar pain (4.8 ± 4.4 vs. 1.1 ± 2.4; P = 0.081) and sternoclavicular joint pain (3.2 ± 3.8 vs. 2.0 ± 2.6; P = 0.194) did not significantly improve. Diarrhea was observed in 60.0% of our patients. Conclusion Our study demonstrated that apremilast can effectively treat cutaneous manifestations and arthralgia in Japanese patients with PPP who had apparent pustules and/or clavicular‐sternocostal arthralgia. Owing to the retrospective design of the study and a small sample size, placebo‐controlled clinical trials with a larger number of patients are warranted to confirm the efficacy of apremilast for treatment of PPP.
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Affiliation(s)
- Noriko Kato
- Department of Dermatology, Aichi Medical University, Aichi, Japan
| | - Hiroyuki Takama
- Department of Dermatology, Aichi Medical University, Aichi, Japan.,Department of Dermatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoriko Ando
- Department of Dermatology, Aichi Medical University, Aichi, Japan
| | | | - Yuichiro Ohshima
- Department of Dermatology, Aichi Medical University, Aichi, Japan
| | - Wataru Ohashi
- Clinical Research Center, Aichi Medical University, Aichi, Japan
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Daisuke Watanabe
- Department of Dermatology, Aichi Medical University, Aichi, Japan
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12
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Serizawa N, Okazaki S, Otsuka Y, Koto M, Okabe K, Ito M, Morita T, Hoashi T, Saeki H, Abe N, Mori M, Okubo Y, Yano Y, Mitsui H, Kanda N. Dietary habits in Japanese patients with palmoplantar pustulosis. J Dermatol 2021; 48:366-375. [DOI: 10.1111/1346-8138.15719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/13/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Naotaka Serizawa
- Department of Dermatology Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
- Department of Dermatology Nippon Medical School Bunkyo‐Ku Tokyo Japan
| | - Shizuka Okazaki
- Department of Dermatology Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
| | - Yohei Otsuka
- Department of Dermatology Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
| | - Mototaka Koto
- Department of Dermatology Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
| | - Kyochika Okabe
- Department of Dermatology Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
| | - Michiko Ito
- Department of Dermatology Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
| | - Takashi Morita
- Department of Dermatology Nippon Medical School Bunkyo‐Ku Tokyo Japan
| | - Toshihiko Hoashi
- Department of Dermatology Nippon Medical School Bunkyo‐Ku Tokyo Japan
| | - Hidehisa Saeki
- Department of Dermatology Nippon Medical School Bunkyo‐Ku Tokyo Japan
| | - Namiko Abe
- Department of Dermatology Nippon Medical School Bunkyo‐Ku Tokyo Japan
| | - Miho Mori
- Department of Dermatology Tokyo Medical University Shinjuku‐Ku Tokyo Japan
| | - Yukari Okubo
- Department of Dermatology Tokyo Medical University Shinjuku‐Ku Tokyo Japan
| | - Yumiko Yano
- Department of Dermatology Tokyo Medical University Shinjuku‐Ku Tokyo Japan
| | - Hiroshi Mitsui
- Department of Dermatology Tokyo Teishin Hospital Chiyoda‐Ku Tokyo Japan
| | - Naoko Kanda
- Department of Dermatology Nippon Medical School Chiba Hokusoh Hospital Inzai Chiba Japan
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13
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Huang C, Tsai T. Clinical characteristics, genetics, comorbidities and treatment of palmoplantar pustulosis: A retrospective analysis of 66 cases in a single center in Taiwan. J Dermatol 2020; 47:1046-1049. [DOI: 10.1111/1346-8138.15470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 05/25/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Chang‐Ming Huang
- Department of Dermatology National Taiwan University Hospital Taipei Taiwan
| | - Tsen‐Fang Tsai
- Department of Dermatology National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
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14
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Yamamoto T, Fukuda K, Morita A, Kimura T, Morishima H, Goto R, Zheng R, Terui T. Efficacy of guselkumab in a subpopulation with pustulotic arthro-osteitis through week 52: an exploratory analysis of a phase 3, randomized, double-blind, placebo-controlled study in Japanese patients with palmoplantar pustulosis. J Eur Acad Dermatol Venereol 2020; 34:2318-2329. [PMID: 32173916 PMCID: PMC7586986 DOI: 10.1111/jdv.16355] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/18/2020] [Indexed: 12/11/2022]
Abstract
Background Previous studies of guselkumab have demonstrated clinical benefits in patients with plaque‐type psoriasis, generalized pustular psoriasis, erythrodermic psoriasis and palmoplantar pustulosis (PPP). Objective The aim of this exploratory analysis of a double‐blind, multicenter, placebo‐controlled, phase 3 study in Japanese patients with PPP was to evaluate the efficacy of guselkumab in the subset of patients with pustulotic arthro‐osteitis (PAO). Methods Patients were randomized to receive guselkumab 100 or 200 mg at weeks 0, 4, 12 and every 8 weeks, or placebo with cross‐over to guselkumab 100 or 200 mg at week 16 (placebo group). Efficacy endpoints were changes from baseline in magnetic resonance imaging (MRI) score, EuroQOL‐5 dimensions (EQ‐5D) index score, EQ‐5D pain/discomfort dimension score and C‐reactive protein (CRP, mg/L) level in all PAO patients through week 52. Data from both guselkumab groups were combined and presented as results for a single overall guselkumab group. Results Among 159 patients with PPP, 66 with PAO were randomized across treatment groups. For patients with MRI data for all regions assessed, the proportion of patients in the guselkumab group with PAO characterized as severe decreased from 23.8% (10/42) at baseline to 5.4% (2/42) at week 52. The mean (SD) change from baseline at week 52 in EQ‐5D index score was 0.20 (0.17) among PPP patients with PAO and 0.15 (0.17) among those without PAO in the guselkumab group. Among all PAO patients, the proportions with an EQ‐5D pain/discomfort dimension score of no or slight pain/discomfort in the guselkumab group increased from baseline to week 52 [33.3% (7/21) vs. 87.5% (35/40)]. The mean (SD) CRP levels decreased in all PAO patients in the guselkumab group at week 52 compared to baseline [−1.71 (8.16) mg/L]. Conclusion Guselkumab treatment showed beneficial outcomes for PAO signs and symptoms in Japanese patients with PPP.
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Affiliation(s)
- T Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - K Fukuda
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - A Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - T Kimura
- Janssen Pharmaceutical K.K, Tokyo, Japan
| | | | - R Goto
- Janssen Pharmaceutical K.K, Tokyo, Japan
| | - R Zheng
- Janssen Pharmaceutical K.K, Tokyo, Japan
| | - T Terui
- Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
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15
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Kikuchi N, Yamamoto T. Effects of apremilast on pustulotic arthro‐osteitis in a real‐world setting: Report of five cases. Dermatol Ther 2020; 33:e13249. [DOI: 10.1111/dth.13249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Nobuyuki Kikuchi
- Department of Dermatology Fukushima Medical University Fukushima Japan
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16
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Yamamoto T, Hiraiwa T, Tobita R, Hirano H, Masuda-Kuroki K, Ishii M, Murakami M, Terui T, Okubo Y. Characteristics of Japanese patients with pustulotic arthro-osteitis associated with palmoplantar pustulosis: a multicenter study. Int J Dermatol 2020; 59:441-444. [PMID: 31985054 DOI: 10.1111/ijd.14788] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/03/2019] [Accepted: 12/23/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pustulotic arthro-osteitis (PAO) is a major comorbidity of palmoplantar pustulosis (PPP), which is frequently seen in Japanese patients. To determine the characteristics of Japanese patients with PAO, we conducted a multicenter, retrospective epidemiologic survey at four university hospitals. METHODS Clinical features including age, gender, duration of disease, extrapalmoplantar lesion, smoking habit, focal infection, site of joint pain, bone scintigraphy with Technetium99 , and therapies were retrospectively evaluated. RESULTS In total, 165 patients with PAO were identified among 576 patients with PPP (28.6%). The male to female ratio was 1 : 3.7, and the mean age was 50.2 years. The mean disease duration of PAO was 6.0 years. Smoking habit was observed in 104 patients. Focal infection was detected in 74 patients, who developed tonsillar infection (n = 41), sinusitis (8), odontogenic infection (40), and others (2). Fifteen patients had multifocal infection. Technetium bone scintigraphy was performed in 97 cases. Increased uptake was most frequently observed in the sternocostoclavicular regions, followed by wrist and ankle, sacroiliac joint, knee and elbow, finger and toe, lumbar spine, thoracic spine, scapula, and thigh. Patients were mainly treated with nonsteroidal anti-inflammatory drugs, methotrexate, cyclosporine, antibiotics, and biologics, as well as tonsillectomy and dental treatment. CONCLUSION PAO frequently involves the anterior chest wall of middle-aged women with smoking habit and is closely associated with focal infection.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Tomoko Hiraiwa
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Rie Tobita
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Hirofumi Hirano
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | | | - Madoka Ishii
- Department of Dermatology, Nihon University, Tokyo, Japan
| | | | - Tadashi Terui
- Department of Dermatology, Nihon University, Tokyo, Japan
| | - Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
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17
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Harabuchi Y, Takahara M. Pathogenic role of palatine tonsils in palmoplantar pustulosis: A review. J Dermatol 2019; 46:931-939. [PMID: 31556151 DOI: 10.1111/1346-8138.15100] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 08/26/2019] [Indexed: 01/12/2023]
Abstract
Palmoplantar pustulosis (PPP) is characterized by symmetrical, erythematous, scaly plaques, with numerous, sterile, non-bacterial, pinpoint pustules, which are restricted to the palms and soles. Because several reports have described the efficacy of tonsillectomy for improvement in PPP skin lesions, we consider that PPP is tonsil-induced autoimmune/inflammatory syndrome (TIAS) while other factors are also involved in the pathogenesis of PPP. Here, the association between PPP pathogenesis and TIAS was examined, with a focus on results of previous studies. PPP patients show a hyperimmune response to indigenous bacteria such as α-streptococci, due to impaired immunological tolerance towards such organisms. Such a novel immune response leads to T-cell activation through the abnormal expression of secondary stimulation molecules, including cytotoxic T-lymphocyte-associated antigen 4, inducible T-cell co-stimulator and Smad7, in the tonsils of PPP patients. Activated tonsillar T cells express cutaneous lymphocyte antigen (CLA), CCR6 and β1-integrin, enter the blood circulation and are recruited to PPP skin lesions. Within lesions, T cells roll onto endothelial cells through the interaction between CLA and E-selectin, migrate into the extravascular area through β1-integrin-vascular cell adhesion molecule 1 binding, and assemble in the skin through CCL20-CCR6 binding. Hyperimmune responses to autoantigens such as keratin and heat shock proteins could also be involved in PPP pathogenesis, through the stimulation of the T-helper 17 reaction.
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Affiliation(s)
- Yasuaki Harabuchi
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Miki Takahara
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Japan
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