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Helpful clinical features for differential diagnosis of palmoplantar pustulosis and pompholyx
2671
2339
Granulomatous pigmented purpuric dermatosis: Report of a case and review of the literature Adam Allan, DO, Saint Joseph Mercy Health System, Ypsilanti, MI, United States; David Altman, MD, Saint Joseph Mercy Health System, Ypsilanti, MI, United States; Wei Su, MD, Saint Joseph Mercy Health System, Ypsilanti, MI, United States
Helpful clinical features for differential diagnosis of palmoplantar pustulosis and pompholyx Sihyeok Jang, MD, Department of Dermatology, Seoul National University Boramae Hospital, Seoul, South Korea; Min-Woo Kim, MD, Department of Dermatology, Seoul National University Boramae Hospital, Seoul, South Korea; Hyun Sun Park, MD, PhD, Department of Dermatology, Seoul National University Boramae Hospital, Seoul, South Korea; Hyun-Sun Yoon, MD, PhD, Department of Dermatology, Seoul National University Boramae Hospital, Seoul, South Korea; Soyun Cho, MD, PhD, Department of Dermatology, Seoul National University Boramae Hospital, Seoul, South Korea
Granulomatous pigmented purpuric dermatosis is a rare histologic variant described in 1996 by Saito and Matsuoa. It was described as classical histologic changes of pigmented purpuric dermatoses with superimposed granulomas. This variant is thought to be associated with hyperlipidemia and found predominantly in individuals of far east Asia; however, a literature review of 26 documented cases including ours, reveals these associations might be becoming less clear. We report an additional case of granulomatous pigmented purpuric dermatosis in a white male with an eruption involving the majority of the lower extremities. Our patient represents the seventh male and eleventh patient to present without hyperlipidemia. Commercial support: None identified.
Background: Palmoplantar pustulosis (PPP) and pompholyx are both chronic vesiculopustular conditions of palms and soles. Because both PPP and pompholyx share similar clinical and histological features, it is difficult to differentiate between these two diseases even for dermatologists. Objective: To analyze for clinical features that can be helpful in differentiating the two diseases. Method: The clinical history from 133 patients with vesicles or pustules on palms and/or soles was evaluated and statistically analyzed. Patients were divided into PPP group and pompholyx group based on the information obtained from medical records such as clinical presentations, comorbidities, histopathologic diagnosis and treatment response. Result: There was no sexual or age predilection in either group and no significant difference in overall localization and symmetry of lesions. Lesions were 56.9% palmoplantar, 13.9% palmar and 29.2% plantar in PPP group. In pompholyx group, lesions were 62.3% palmoplantar, 16.4% palmar and 21.3% plantar. Bilaterality was found in 75.0% of PPP and 82.0% of pompholyx. More lesions were found on the tip of the finger (P ¼.012 (right), P ¼.003 (left)), tip of the toe (P ¼.016 (right), P ¼.037 (left)) and the side of the toe (P ¼.046 (right), P ¼.046 (left)) in pompholyx patients. However, there was no difference between two groups in the lesions on the sides of fingers. More PPP lesions involved right DIP (P ¼.038), left PIP (P ¼.01), and right PIP (P ¼ .001) joint areas compared with pompholyx. There were more past or current smokers in PPP group (P ¼ .01). There was no association between the smoking history or the amount of smoking consumption and the location, distribution, or extent of involvement in each body part in PPP group. In pompholyx group, current or previous smokers had more lesions on the tip of the fingers, thenar area and hypothenar area. Among several comorbidities, only atopic dermatitis (P ¼ .024) and nummular eczema (P ¼ .019) were more frequently associated with pompholyx. Conclusion: Several characteristics of patients and clinical findings may serve as useful ‘clues’ to differentiate between and determine treatment for PPP and pompholyx. At the same time, the two diseases may share some pathogenic mechanisms, as seen by some overlapping clinical features.
3191 Health related quality of life and work productivity impairment among patients with moderate to severe psoriasis in Taiwan Yu-Huei Huang, MD, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Tsen-FangTsai, MD, National Taiwan University, Taipei, Taiwan; Yi-Chen Ho, MD, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Yi-Ju Chen, MD, PhD, Taichung Veterans General Hospital, Taichung, Taiwan; Michael Yao-Hsien Wang, MD, Medical Affairs, Janssen Pharmaceuticals, Taipei, Taiwan; Gong-Yau Chu, MD, Medical Affairs, Janssen Pharmaceuticals, Taipei, Taiwan; Tim Teng-Hsu Wang, PhD, Medical Affairs, Janssen Pharmaceuticals, Taipei, Taiwan Background: Plaque psoriasis is a chronic, systemic autoimmune disorder which can cause significant physical discomfort and psychological distress. The aim of this study was to document the health-related quality of life (HRQoL) in patients with moderate to severe plaque psoriasis in Taiwan. Methods: This was a multicenter, noninterventional, cross-sectional study. Patients with moderate/severe psoriasis attended a single clinic visit at which they completed assessments including body surface area (BSA), Psoriasis Area Severity Index (PASI), Dermatology Life Quality Index (DLQI), Euro Quality of Life-5 Dimensions (EQ-5D), 10-level satisfaction scale for psoriasis treatment, and Working Productivity and Activity Impairment (WPAI). Data analyses included descriptive statistics and a regression model to assess predictors of HRQoL and WPAI. Results: 305 patients with moderate to severe psoriasis were included. The average age was 43.7 years, and 82.0% of patients were male. The mean PASI score was 11.8 (95% confidence interval (CI), 10.83-12.83), and 64.6% of patients had a BSA involvement of[10% at the time of analysis. The mean DLQI score was 12.6 (95% CI, 11.72-13.38), with 56.1% of patients scoring over 10. The mean EQ-5D visual analogue scale (VAS) score was 65.7 (95% CI, 63.5-67.9). The majority of patients were receiving standard therapy at the time of the survey, however, only 45.7% reported being satisfied with treatment. 42% of patients had previously received traditional Chinese or herbal treatment, and yet only 3.9% reported being satisfied with treatment. Results from the WPAI questionnaire, completed by the 219 patients who were employed, indicated that the mean work time missed was 3.2%, mean overall work productivity loss was 33.3%, and mean impairment in activity was 41.0%. The regression analysis indicated that patients of a younger age and those with more severe psoriasis show greater impairment in HRQoL and WPAI domains. Patients who were satisfied with current treatment were more likely to have better health condition, better health perception, and less impairment in HRQoL.
Commercial support: None identified.
2495 Hidradenitis suppurativa and lung diseases: A study of 3207 patients Ronen Magun, MD, Soroka Medical Center, Beer Sheva, Israel; Guy Shalom, MD, Soroka Medical Center, Beer Sheva, Israel; Arnon Dov Cohen, MD, PhD, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Beer-Sheva, Israel Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition, also known as acne inversa. HS is associated with inflammatory and genetic disorders. To the best of our knowledge, an association between HS and lung diseases has never been reported to-date.
Conclusions: The results of this study indicate that Taiwanese patients with moderate to severe plaque psoriasis exhibit moderately reduced HRQoL, and some impairment in work productivity. Less than 50% of patients are satisfied with standard therapy, and less than 4% of patients report satisfaction with traditional Chinese or herbal treatments.
Objective: To investigate the association between HS and two lung diseases: chronic obstructive pulmonary disease (COPD) and asthma. Methods: A cross-sectional study was performed utilizing the database of the Clalit Health Services (CHS). Case patients were defined as having HS in their records, diagnosed by a dermatologist. Control patients without HS were matched by age and gender. Dichotomous variables were compared by Pearson’s chi-square or Fisher’s exact test. Continuous variables were compared by the use of analysis of variance (ANOVA) or T-tests. The associations between HS and COPD or asthma were tested in multivariate analyses. Results: The study population included 3207 patients with HS and 6412 controls. Among HS patients, 7.4% (236) had asthma and 2.7% (86) had COPD, compared to 5.3% (339) with asthma and 1.6% (105) with COPD in the control group. Using multivariate analyses, a significant association was observed between HS and asthma (OR 1.3; 95% CI 1.1-1.6) and between HS and COPD (OR 1.4; 95% CI 1.0-1.8). Conclusion: In the current study, HS was associated with asthma and COPD. Physicians taking care of patients with HS should be aware of these associations.
Supported by Janssen Pharmaceuticals.
Commercial support: None identified.
MAY 2016
J AM ACAD DERMATOL
AB55
2339
Granulomatous pigmented purpuric dermatosis: Report of a case and review of the literature Adam Allan, DO, Saint Joseph Mercy Health System, Ypsilanti, MI, United States; David Altman, MD, Saint Joseph Mercy Health System, Ypsilanti, MI, United States; Wei Su, MD, Saint Joseph Mercy Health System, Ypsilanti, MI, United States
Helpful clinical features for differential diagnosis of palmoplantar pustulosis and pompholyx Sihyeok Jang, MD, Department of Dermatology, Seoul National University Boramae Hospital, Seoul, South Korea; Min-Woo Kim, MD, Department of Dermatology, Seoul National University Boramae Hospital, Seoul, South Korea; Hyun Sun Park, MD, PhD, Department of Dermatology, Seoul National University Boramae Hospital, Seoul, South Korea; Hyun-Sun Yoon, MD, PhD, Department of Dermatology, Seoul National University Boramae Hospital, Seoul, South Korea; Soyun Cho, MD, PhD, Department of Dermatology, Seoul National University Boramae Hospital, Seoul, South Korea
Granulomatous pigmented purpuric dermatosis is a rare histologic variant described in 1996 by Saito and Matsuoa. It was described as classical histologic changes of pigmented purpuric dermatoses with superimposed granulomas. This variant is thought to be associated with hyperlipidemia and found predominantly in individuals of far east Asia; however, a literature review of 26 documented cases including ours, reveals these associations might be becoming less clear. We report an additional case of granulomatous pigmented purpuric dermatosis in a white male with an eruption involving the majority of the lower extremities. Our patient represents the seventh male and eleventh patient to present without hyperlipidemia. Commercial support: None identified.
Background: Palmoplantar pustulosis (PPP) and pompholyx are both chronic vesiculopustular conditions of palms and soles. Because both PPP and pompholyx share similar clinical and histological features, it is difficult to differentiate between these two diseases even for dermatologists. Objective: To analyze for clinical features that can be helpful in differentiating the two diseases. Method: The clinical history from 133 patients with vesicles or pustules on palms and/or soles was evaluated and statistically analyzed. Patients were divided into PPP group and pompholyx group based on the information obtained from medical records such as clinical presentations, comorbidities, histopathologic diagnosis and treatment response. Result: There was no sexual or age predilection in either group and no significant difference in overall localization and symmetry of lesions. Lesions were 56.9% palmoplantar, 13.9% palmar and 29.2% plantar in PPP group. In pompholyx group, lesions were 62.3% palmoplantar, 16.4% palmar and 21.3% plantar. Bilaterality was found in 75.0% of PPP and 82.0% of pompholyx. More lesions were found on the tip of the finger (P ¼.012 (right), P ¼.003 (left)), tip of the toe (P ¼.016 (right), P ¼.037 (left)) and the side of the toe (P ¼.046 (right), P ¼.046 (left)) in pompholyx patients. However, there was no difference between two groups in the lesions on the sides of fingers. More PPP lesions involved right DIP (P ¼.038), left PIP (P ¼.01), and right PIP (P ¼ .001) joint areas compared with pompholyx. There were more past or current smokers in PPP group (P ¼ .01). There was no association between the smoking history or the amount of smoking consumption and the location, distribution, or extent of involvement in each body part in PPP group. In pompholyx group, current or previous smokers had more lesions on the tip of the fingers, thenar area and hypothenar area. Among several comorbidities, only atopic dermatitis (P ¼ .024) and nummular eczema (P ¼ .019) were more frequently associated with pompholyx. Conclusion: Several characteristics of patients and clinical findings may serve as useful ‘clues’ to differentiate between and determine treatment for PPP and pompholyx. At the same time, the two diseases may share some pathogenic mechanisms, as seen by some overlapping clinical features.
3191 Health related quality of life and work productivity impairment among patients with moderate to severe psoriasis in Taiwan Yu-Huei Huang, MD, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Tsen-FangTsai, MD, National Taiwan University, Taipei, Taiwan; Yi-Chen Ho, MD, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Yi-Ju Chen, MD, PhD, Taichung Veterans General Hospital, Taichung, Taiwan; Michael Yao-Hsien Wang, MD, Medical Affairs, Janssen Pharmaceuticals, Taipei, Taiwan; Gong-Yau Chu, MD, Medical Affairs, Janssen Pharmaceuticals, Taipei, Taiwan; Tim Teng-Hsu Wang, PhD, Medical Affairs, Janssen Pharmaceuticals, Taipei, Taiwan Background: Plaque psoriasis is a chronic, systemic autoimmune disorder which can cause significant physical discomfort and psychological distress. The aim of this study was to document the health-related quality of life (HRQoL) in patients with moderate to severe plaque psoriasis in Taiwan. Methods: This was a multicenter, noninterventional, cross-sectional study. Patients with moderate/severe psoriasis attended a single clinic visit at which they completed assessments including body surface area (BSA), Psoriasis Area Severity Index (PASI), Dermatology Life Quality Index (DLQI), Euro Quality of Life-5 Dimensions (EQ-5D), 10-level satisfaction scale for psoriasis treatment, and Working Productivity and Activity Impairment (WPAI). Data analyses included descriptive statistics and a regression model to assess predictors of HRQoL and WPAI. Results: 305 patients with moderate to severe psoriasis were included. The average age was 43.7 years, and 82.0% of patients were male. The mean PASI score was 11.8 (95% confidence interval (CI), 10.83-12.83), and 64.6% of patients had a BSA involvement of[10% at the time of analysis. The mean DLQI score was 12.6 (95% CI, 11.72-13.38), with 56.1% of patients scoring over 10. The mean EQ-5D visual analogue scale (VAS) score was 65.7 (95% CI, 63.5-67.9). The majority of patients were receiving standard therapy at the time of the survey, however, only 45.7% reported being satisfied with treatment. 42% of patients had previously received traditional Chinese or herbal treatment, and yet only 3.9% reported being satisfied with treatment. Results from the WPAI questionnaire, completed by the 219 patients who were employed, indicated that the mean work time missed was 3.2%, mean overall work productivity loss was 33.3%, and mean impairment in activity was 41.0%. The regression analysis indicated that patients of a younger age and those with more severe psoriasis show greater impairment in HRQoL and WPAI domains. Patients who were satisfied with current treatment were more likely to have better health condition, better health perception, and less impairment in HRQoL.
Commercial support: None identified.
2495 Hidradenitis suppurativa and lung diseases: A study of 3207 patients Ronen Magun, MD, Soroka Medical Center, Beer Sheva, Israel; Guy Shalom, MD, Soroka Medical Center, Beer Sheva, Israel; Arnon Dov Cohen, MD, PhD, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Beer-Sheva, Israel Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition, also known as acne inversa. HS is associated with inflammatory and genetic disorders. To the best of our knowledge, an association between HS and lung diseases has never been reported to-date.
Conclusions: The results of this study indicate that Taiwanese patients with moderate to severe plaque psoriasis exhibit moderately reduced HRQoL, and some impairment in work productivity. Less than 50% of patients are satisfied with standard therapy, and less than 4% of patients report satisfaction with traditional Chinese or herbal treatments.
Objective: To investigate the association between HS and two lung diseases: chronic obstructive pulmonary disease (COPD) and asthma. Methods: A cross-sectional study was performed utilizing the database of the Clalit Health Services (CHS). Case patients were defined as having HS in their records, diagnosed by a dermatologist. Control patients without HS were matched by age and gender. Dichotomous variables were compared by Pearson’s chi-square or Fisher’s exact test. Continuous variables were compared by the use of analysis of variance (ANOVA) or T-tests. The associations between HS and COPD or asthma were tested in multivariate analyses. Results: The study population included 3207 patients with HS and 6412 controls. Among HS patients, 7.4% (236) had asthma and 2.7% (86) had COPD, compared to 5.3% (339) with asthma and 1.6% (105) with COPD in the control group. Using multivariate analyses, a significant association was observed between HS and asthma (OR 1.3; 95% CI 1.1-1.6) and between HS and COPD (OR 1.4; 95% CI 1.0-1.8). Conclusion: In the current study, HS was associated with asthma and COPD. Physicians taking care of patients with HS should be aware of these associations.
Supported by Janssen Pharmaceuticals.
Commercial support: None identified.
MAY 2016
J AM ACAD DERMATOL
AB55