Background: Little is known about the clinical characteristics, diagnostic delay and treatment survival in patients with palmoplantar pustulosis (PPP).
Objectives: To analyse the survival rates of patients with PPP in Austria treated with phototherapy, conventional systemic therapies and biologics.
Methods: This was a retrospective study using data from the Psoriasis Registry Austria (PsoRA). The analysis included data collected between 16 May 1997 and 11 April 2024 from patients with PPP.
Results: We included data from 190 patients who underwent 397 treatments. Fifty-four per cent of patients (n = 37/69) were initially misdiagnosed as having eczema with a mean (SD) diagnostic delay of 2.8 (4.8) years. Patients were predominantly women (n = 141/190; 74.2%) and smoked (n = 76/98; 78%). Patients were treated with biologics (n = 198/397; 49.9%), phototherapy (n = 100/397; 25.2%) and conventional systemic therapies (n = 99/397; 24.9%). Median survival time for all treatments was 0.6 years [95% confidence interval (CI) 0.5-0.8], with patients on ustekinumab having the longest median survival time of 2.7 years (95% CI 2.3-upper limit not reached), surpassing all other therapies. This superiority disappeared after interleukin (IL)-23p19 inhibitors were introduced in Austria. Compared with biologics, conventional systemic treatments [hazard ratio (HR) 2.17; P < 0.001] and phototherapy (HR 4.43; P < 0.001) were associated with a significantly higher risk of treatment discontinuation. In the overall cohort, disease durations of ≥ 2 to < 10 years (HR 0.66; P = 0.05) and ≥ 10 years (HR 0.59; P = 0.004) significantly reduced the risk of treatment discontinuation, while concomitant plaque psoriasis significantly increased the risk of treatment discontinuation (HR 1.43; P = 0.05). In the biologic cohort, concomitant arthritis (HR 2.11; P = 0.002) and the presence of one comorbid disease (HR 2.34; P = 0.03) increased the risk of treatment discontinuation. Furthermore, sex, age at disease onset and smoking did not influence the risk of treatment discontinuation.
Conclusions: Our findings suggest that more than half of patients with PPP experience a diagnostic delay of several years due to an initial misdiagnosis. Patients on ustekinumab (IL-12/23p40 inhibitor) had the longest treatment survival, although its superiority diminished with the introduction of IL-23p19 inhibitors. Finally, shorter disease duration and concomitant plaque psoriasis is a general risk factor for treatment discontinuation, while the presence of a comorbidity and concomitant psoriatic arthritis are risk factors for discontinuing biologics.
Palmoplantar pustulosis is a rare skin disease of the palms of the hands and soles of the feet. The disease affects people’s quality of life. Patients with the disease often have many other conditions. We wanted to find out how patients with the disease in Austria are diagnosed and treated. Using a database called the ‘Psoriasis Registry Austria’, we found 190 patients with the disease. These 190 patients were treated with 397 different therapies. Over half of patients were initially misdiagnosed with eczema. This led to an average delay of about 3 years before patients received the correct diagnosis. Most patients were women and most smoked. The most common treatment was with medications called ‘biologics’. These target specific inflammatory molecules. Patients stayed on treatment with a biologic called ustekinumab for the longest amount of time. Patients were more likely to stop other types of medication and light therapy earlier than if they were taking biologics. Psoriasis and not having had the disease for a long time increased the risk of patients stopping treatment. Age, patient sex and smoking did not affect treatment duration. Many patients with palmoplantar pustulosis have a long wait before they are diagnosed correctly. Despite advances in therapies, the disease remains difficult to treat. A drug called ustekinumab showed the best long-term treatment survival.
© The Author(s) 2025. Published by Oxford University Press on behalf of British Association of Dermatologists.