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Fukumoto T, Horita N, Yoshioka A. Recurrent palmoplantar pustulosis at the site of insertion of therapeutic titanium. J Dermatol 2023; 50:e223-e225. [PMID: 36805619 DOI: 10.1111/1346-8138.16750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/22/2023]
Affiliation(s)
- Takeshi Fukumoto
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Hospital, Yokohama, Japan
| | - Ai Yoshioka
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
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2
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Löfvendahl S, Norlin JM, Schmitt-Egenolf M. Comorbidities in palmoplantar pustulosis: a Swedish population-based register study. Br J Dermatol 2023:7191697. [PMID: 37285288 DOI: 10.1093/bjd/ljad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/16/2023] [Accepted: 04/25/2023] [Indexed: 06/09/2023]
Abstract
This study investigated the comorbidity burden of Swedish patients with palmoplantar pustulosis (PPP) vs. the general population and patients with psoriasis vulgaris (PV). We found a significantly higher comorbidity burden in patients with PPP compared with the general population, represented by higher odds for disease across different categories (metabolic, cerebrovascular, cardiovascular, psychiatric). Although patients with PPP and PV showed similar comorbidity burdens overall, the comorbidity profiles differed significantly. Comorbidities such as type 2 diabetes and chronic obstructive pulmonary disorder, which showed both high prevalence (> 5%) in PPP and higher odds than PV, may be of particular importance for the specific comorbidity burden of PPP.
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Affiliation(s)
- Sofia Löfvendahl
- The Swedish Institute for Health Economics (IHE), Lund
- Department of Laboratory Medicine, Lund University, Lund
| | | | - Marcus Schmitt-Egenolf
- Department of Public Health and Clinical Medicine, Dermatology, Umeå University, Umeå, Sweden
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3
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Metal Allergy Mediates the Development of Oral Lichen Planus via TSLP-TSLPR Signaling. J Clin Med 2022; 11:jcm11030519. [PMID: 35159975 PMCID: PMC8836592 DOI: 10.3390/jcm11030519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/31/2021] [Accepted: 01/18/2022] [Indexed: 01/27/2023] Open
Abstract
Metal allergy is a T-cell-mediated delayed type of hypersensitive reaction. The pathogenetic mechanisms underlying the allergy are unclear, although the condition has been reported to be related to oral lichen planus (OLP), despite an absence of immunological studies to support this relationship. In this study, histopathological samples of OLP patients were examined to compare the metal allergy-positive and -negative groups, with a focus on the network of epidermal keratinocytes and T cells induced by thymic stromal lymphopoietin (TSLP) and its receptor, TSLPR. Infiltration of T cells into the epithelium was revealed to be higher in the OLP lesions of metal allergy-positive patients than in those of metal allergy-negative patients. Moreover, TSLP-TSLPR signaling and TNF-α production were higher in the epithelial tissue samples of the metal allergy-positive patients than in the metal allergy-negative patients. Metal allergy is associated with both increased expressions of TSLP in keratinocytes and increased TNF-α levels in the epithelium. We propose that this would promote the accumulation of T cells at the lesion site, contributing to the formation of the disease. These results suggest that metal allergy may be an aggravating factor in the pathogenesis of OLP.
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Kashiyama K, Lee J, Koga K, Matsuo Y, Tanaka K. Improvement of palmoplantar pustulosis after excision of polyacrylamide injected into the nasal region. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2021; 8:186-190. [PMID: 34790838 PMCID: PMC8592594 DOI: 10.1080/23320885.2021.2002155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report a patient in whom polyacrylamide hydrogel injected into the nasal region caused palmoplantar pustulosis. We report this case because few cases of autoimmune syndrome induced by adjuvants caused by polyacrylamide have been reported.
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Affiliation(s)
- Kazuya Kashiyama
- Department of Plastic and Reconstructive Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Jinyoung Lee
- Department of Plastic and Reconstructive Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Kazufumi Koga
- Department of Plastic and Reconstructive Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Yumi Matsuo
- Department of Plastic and Reconstructive Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Katsumi Tanaka
- Department of Plastic and Reconstructive Surgery, Nagasaki University Hospital, Nagasaki, Japan
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Takaoka Y, Akiba Y, Nagasawa M, Ito A, Masui Y, Akiba N, Eguchi K, Miyazawa H, Tabeta K, Uoshima K. The relationship between dental metal allergy, periodontitis, and palmoplantar pustulosis: An observational study. J Prosthodont Res 2021; 66:438-444. [PMID: 34588402 DOI: 10.2186/jpr.jpr_d_20_00307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE This study aimed to investigate the relationship between dental metal allergy, periodontitis, and palmoplantar pustulosis among patients from a dental metal allergy clinic over a period of 8 years. METHODS This study included 436 patients who visited our dental metal allergy clinic between April 1, 2009 and March 31, 2016. Diagnoses of skin diseases, periodontal records, dental metal series patch test results, and electron probe microanalysis (EPMA) data were obtained from medical records. Relative risk (RR) values were estimated from these data. RESULTS Of the 359 patients who underwent the patch test, 241 showed a positive reaction. Of the 187 patients who underwent EPMA, 113 had allergenic metals in their dental prostheses. These patients were suspected to have a dental metal allergy. Furthermore, 150 of the 436 patients were diagnosed with palmoplantar pustulosis (PPP). The RR of metal allergy between patients with PPP and healthy subjects was 3.88. The RR of periodontal disease between patients with PPP and PPP-negative patients in the national average was 2.54. CONCLUSIONS In this study, both dental metal allergy and periodontitis showed a high RR for PPP.
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Affiliation(s)
- Yurina Takaoka
- Division of Bio-Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan
| | - Yosuke Akiba
- Division of Bio-Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan
| | - Masako Nagasawa
- Division of Bio-Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan
| | - Akiko Ito
- Department of Dermatology, Nagata Clinic, Niigata, Japan.,Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yukiko Masui
- Department of Dermatology, Nagata Clinic, Niigata, Japan.,Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Nami Akiba
- Division of Bio-Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan
| | - Kaori Eguchi
- Division of Bio-Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan
| | - Haruna Miyazawa
- Division of Periodontology, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan.,Clinical and Translational Research Center, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Koichi Tabeta
- Division of Periodontology, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan
| | - Katsumi Uoshima
- Division of Bio-Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan
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Abstract
Palmoplantar pustulosis (PPP) is a chronic inflammatory condition where crops of sterile pustules with erythematous keratotic lesions causing bleeding and pain appear on the palms and soles. Recently, the European Rare and Severe Expert Network considered PPP as a variant of pustular psoriasis with or without psoriasis vulgaris. The prevalence of PPP varies from 0.050 to 0.12%. PPP occurs more frequently in women and the highest prevalence occurred between the ages of 50 and 69 years. Nail psoriasis seems to be frequent in PPP, ranging from 30 to 76%, and psoriatic arthritis in 8.6 to 26% of PPP patients. Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome and pustulotic arthro-osteitis are considered PPP-associated disorders. PPP has been reported with other co-morbidities such as psychiatric disorders, thyroid-associated disease, altered calcium homeostasis, gluten sensitivity diabetes, obesity, and dyslipidemia, but larger studies are required to prove such associations. Environmental exacerbating factors might contribute to the onset or worsening of PPP such as cigarette smoking, stress, focal infections, metal allergies, and drug intake. Genetic predisposition plays an important role in PPP. In PPP, both the innate and the adaptive immune systems are activated. The acrosyringeal expression of IL-17 has been demonstrated, indicating that the eccrine sweat gland is an active component of the skin barrier and an immune-competent structure. Increased levels of several inflammatory molecules, including IL-8, IL-1α, IL-1β, IL-17A, IL-17C, IL-17D, IL-17F, IL-22, IL-23A, and IL-23 receptor, have been detected in PPP biopsies. Increased serum levels of TNF-α, IL-17, IL-22, and IFN-γ have been detected in patients with PPP in comparison to healthy subjects, suggesting a similar inflammatory pattern to psoriasis vulgaris. Oral and tonsillar infections serve as trigger factors for PPP. Long-term therapy is required for many patients, but high-quality data are limited, contributing to uncertainty about the ideal approach to treatment.
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Brunasso AMG, Massone C. Clinical characteristics, genetics, comorbidities and treatment of palmoplantar pustulosis: A different perspective. J Dermatol 2020; 48:e47. [PMID: 33211364 DOI: 10.1111/1346-8138.15644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Cesare Massone
- Department of Dermatology, Galliera Hospital, Genoa, Italy
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Freitas E, Rodrigues MA, Torres T. Diagnosis, Screening and Treatment of Patients with Palmoplantar Pustulosis (PPP): A Review of Current Practices and Recommendations. Clin Cosmet Investig Dermatol 2020; 13:561-578. [PMID: 32884319 PMCID: PMC7439281 DOI: 10.2147/ccid.s240607] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022]
Abstract
Palmoplantar pustulosis (PPP) is a rare, chronic, recurrent inflammatory disease that affects the palms and/or the soles with sterile, erupting pustules, which are debilitating and usually resistant to treatment. It has genetic, histopathologic and clinical features that are not present in psoriasis; thus, it can be classified as a variant of psoriasis or as a separate entity. Smoking and upper respiratory infections have been suggested as main triggers of PPP. PPP is a challenging disease to manage, and the treatment approach involves both topical and systemic therapies, as well as phototherapy and targeted molecules. No gold standard therapy has yet been identified, and none of the treatments are curative. In patients with mild disease, control may be achieved with on-demand occlusion of topical agents. In patients with moderate-to-severe PPP, phototherapy or a classical systemic agent (acitretin being the best treatment option, especially in combination with PUVA) may be effective. Refractory patients or those with contraindications to use these therapies may be good candidates for apremilast or biologic therapy, particularly anti-IL-17A and anti-IL-23 agents. Recent PPP trials are focusing on blockage of IL-36 or IL-1 pathways, which play an important role in innate immunity. Indeed, IL-36 isoforms have been strongly implicated in the pathogenesis of psoriasis. Therefore, blockage of the IL-36 pathway has become a new treatment target in PPP, and three studies are currently evaluating the use of monoclonal antibodies that block the IL-36 receptor in PPP: ANB019 and spesolimab (BI 655130). In this review, we explore the diagnosis, screening and treatment of patients with PPP.
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Affiliation(s)
- Egídio Freitas
- Department of Dermatology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | | | - Tiago Torres
- Department of Dermatology, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Misiak-Galazka M, Zozula J, Rudnicka L. Palmoplantar Pustulosis: Recent Advances in Etiopathogenesis and Emerging Treatments. Am J Clin Dermatol 2020; 21:355-370. [PMID: 32008176 PMCID: PMC7275027 DOI: 10.1007/s40257-020-00503-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Palmoplantar pustulosis (PPP) is a chronic, recurrent skin disease belonging to the spectrum of psoriasis. It is characterized by an eruption of sterile pustules on the palms and soles. Recent studies in PPP have focused on genetic differences between pustular phenotypes and the role of the innate immunological system and the microbiome in the etiopathogenesis of the disease. Mutations in IL36RN (a major predisposing factor for generalized pustular psoriasis) were found in selected patients with PPP and were associated with earlier disease onset. Studies have shown that the interleukin (IL)-17 and IL-36 pathways might be involved in the pathogenesis of PPP. A microbiome has been demonstrated in the vesicopustules of PPP, and an abundance of Staphylococcus appears to be increased by smoking. Improved understanding of the underlying etiopathogenesis of PPP has led to advances in treatment options, and targeted therapies for PPP have been evaluated or are under evaluation against more than 12 molecules in ongoing clinical trials. These targets include CXCR2 (IL-8 receptor type B), granulocyte colony-stimulating factor receptor, IL-1 receptor, IL-8, IL-12, IL-23, IL-17A, IL-17 receptor, IL-36 receptor, phosphodiesterase-4, and tumor necrosis factor-α.
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Affiliation(s)
| | - Joanna Zozula
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008, Warsaw, Poland.
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Obermeyer L, Skudlik C, John SM, Brans R. [Occupational aspects of palmoplantar pustulosis : Discussion based on the evaluation of retrospective data]. Hautarzt 2020; 71:699-704. [PMID: 32430542 DOI: 10.1007/s00105-020-04611-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease. Its classification as a variant of psoriasis is controversial. Exogenous factors may affect PPP. OBJECTIVES Occupational aspects of PPP based on a retrospective evaluation of patient data are discussed. METHODS Data from 1518 patients who took part in a tertiary prevention program (TIP) for occupational skin diseases in our department between January 2015 and June 2019 were evaluated. RESULTS PPP was diagnosed in 30 patients (1.98%). The hands were affected in all of them, while concomitant feet involvement was found in 83.3%. The majority was female (70.0%) and reported tobacco smoking (83.3%). Systemic treatment was continued or initiated in one third of patients. In only 8 patients (26.7%) was PPP considered to be work-related. CONCLUSIONS PPP is an endogenous disease which is influenced by nonoccupational factors (e.g., tobacco smoking). Therefore, a thorough investigation is mandatory when assessing whether occupational factors are legally essential and exceed aggravation by everyday life. For this purpose, a well-documented course of the disease and a critical appraisal of occupational and nonoccupational factors are crucial. Only if occupational causality is probable can preventive measures be provided by the statutory accident insurance and PPP can be legally recognized as an occupational disease.
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Affiliation(s)
- L Obermeyer
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.
| | - C Skudlik
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.,Institut für Gesundheitsforschung und Bildung (IGB), Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland
| | - S M John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.,Institut für Gesundheitsforschung und Bildung (IGB), Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland
| | - R Brans
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.,Institut für Gesundheitsforschung und Bildung (IGB), Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland
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