Palmoplantar pustulosis - a cross-sectional analysis in Germany

Dermatol Online J. 2017 Apr 15;23(4):13030/qt0h15613d.


Background: Palmoplantar pustulosis (PPP) is a recalcitrant chronic inflammatory skin disease. Data relevant for the medical care of patients with PPP are scarce. Thus, the aim of this work was to investigate the disease burden, clinical characteristics, and comorbidity of PPP patients in Germany.

Patients and methods: PPP patients were examined in a crosssectional study at seven specialized psoriasis centers in Germany.

Results: Of the 172 included patients with PPP, 79.1% were female and 69.8% were smokers.In addition, 25.0% suffered from psoriasis vulgaris, 28.2% had documented psoriatic arthritis, and 30.2% had a family history of psoriasis. In 77 patients the mean Dermatology Life Quality Index (DLQI) was 12.2 ± 7.7 (mean ± SD). The mean Psoriasis Palmoplantar Pustulosis Area and Severity Index (PPPASI) was 12.6 ± 8.6. Mean body mass index was above average at 27.1 ± 5.5. The PPP patients had previously received an average of 2.6 ± 2.1 different anti-psoriatic systemic drugs or UV-therapies. The systemic drugs that had been used most frequently were corticosteroids in 40.1% of patients, followed by acitretin (37.8%), and methotrexate (27.9%). The PPPASI was 13.4 ± 8.9 in patients without current systemic therapy and 10.4 ± 7.9 in patients with systemic therapy.

Conclusion: Many PPP patients had a concomitant diagnosis of psoriasis vulgaris and/or psoriatic arthritis or had a family history of psoriasis. Despite the fact that many of the patients were using anti-psoriatic therapies, there was still a high burden of disease within this PPP cohort. This insufficient control of symptoms demonstrates the urgent need for new PPP treatments.

Publication types

  • Multicenter Study

MeSH terms

  • Acitretin / therapeutic use
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Age of Onset
  • Arthritis, Psoriatic / epidemiology
  • Body Mass Index
  • Comorbidity
  • Cross-Sectional Studies
  • Dermatologic Agents / therapeutic use
  • Female
  • Germany / epidemiology
  • Humans
  • Keratolytic Agents / therapeutic use
  • Male
  • Methotrexate / therapeutic use
  • Middle Aged
  • Psoriasis / epidemiology*
  • Psoriasis / genetics
  • Psoriasis / therapy*
  • Quality of Life
  • Severity of Illness Index
  • Smoking / epidemiology*
  • Ultraviolet Therapy
  • Young Adult


  • Adrenal Cortex Hormones
  • Dermatologic Agents
  • Keratolytic Agents
  • Acitretin
  • Methotrexate