Skip to main content
SpringerLink
Log in

Characteristics and Burdens of Disease in Patients from Beijing with Generalized Pustular Psoriasis and Palmoplantar Pustulosis: Multicenter Retrospective Cohort Study Using a Regional Database

  • Original Research Article
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Background and Objective

Pustular psoriasis is a chronic and recurrent autoimmune disease, although little is known about the disease burden of pustular psoriasis in China. We analyzed the characteristics and disease burdens of patients from Beijing who had generalized pustular psoriasis (GPP) or palmoplantar pustulosis (PPP).

Methods

This multicenter retrospective cohort study used a regional electronic health database that covered 30 public hospitals in Beijing. From June 2016 to June 2021, all patients with a diagnosis of GPP, PPP, or psoriasis vulgaris (PV) were identified by International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes. The GPP and PPP cohorts were separately matched with patients with PV in a 3:1 ratio for comparisons. Demographic data, clinical characteristics, healthcare resource utilization, and costs were collected. Descriptive and comparative analyses were used to compare the cohorts.

Results

There were 744 patients with GPP (46.8% men; age 42.14 ± 21.47 years) and 4808 patients with PPP (35.5% men; age 51.65 ± 16.12 years); 14.5% of patients with GPP had concomitant PV and 7.5% of patients with PPP had concomitant PV. Relative to matched patients with PV, patients with GPP had a higher prevalence of erythrodermic psoriasis (5.9% vs 0.4%, p < 0.0001), psoriatic arthritis (3.1% vs 1.5%, p = 0.007), and organ failure (1.1% vs 0.2%, p = 0.002). Relative to matched patients with PV, patients with PPP had a higher prevalence of cerebrovascular disease (4.7% vs 1.2%, p < 0.0001), thyroid dysfunction (3.9% vs 3.3%, p = 0.035), and type 2 diabetes mellitus (6.8% vs 5.9%, p = 0.030). More patients with GPP than patients with PV received systemic non-biological agents (27.9% vs 3.3%, p < 0.0001) and biologic agents (4.8% vs 2.0%, p = 0.010). More patients with PPP than patients with PV received topical agents (50.9% vs 34.7%, p < 0.0001) and systemic non-biological agents (17.8% vs 2.7%, p < 0.0001). More patients with GPP than patients with PV required inpatient hospitalization (22.0% vs 7.8%, p < 0.0001). Hospitalization stay was longer in patients with GPP than patients with PV (11.72 ± 0.45 vs 10.38 ± 0.45 days, p = 0.022). More patients with PPP than patients with PV had emergency visits (16.3% vs 12.8%, p < 0.0001). The GPP and PPP cohorts and their matched PV cohorts had no significant differences in costs. However, patients with PPP had lower outpatient costs than patients with PV (368.20 ± 8.19 vs 445.38 ± 5.90 Chinese Yuan per patient per month, p < 0.0001).

Conclusions

Patients from Beijing with GPP and PPP had higher disease burdens than matched PV cohorts, including the prevalence of comorbidities, healthcare resource utilization, and medication burden. However, the economic burden of pustular psoriasis was similar to that of PV. Practical and specific therapies are needed to reduce the burdens of pustular psoriasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Twelves S, Mostafa A, Dand N, et al. Clinical and genetic differences between pustular psoriasis subtypes. J Allergy Clin Immunol. 2019. https://doi.org/10.1016/j.jaci.2018.06.038.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Misiak-Galazka M, Wolska H, Rudnicka L. What do we know about palmoplantar pustulosis? J Eur Acad Dermatol Venereol. 2017. https://doi.org/10.1111/jdv.13846.

    Article  PubMed  Google Scholar 

  3. Burden AD, Choon SE, Gottlieb AB, et al. Clinical disease measures in generalized pustular psoriasis. Am J Clin Dermatol. 2022. https://doi.org/10.1007/s40257-021-00653-0.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Liang L-L, Langenbrunner J. The long march to universal coverage: lessons from China. UNICO study series; no. 9. Washington, DC: World Bank; 2013.

    Google Scholar 

  5. Guo ZH. Hospital management. Beijing: People’s Health Publishing House; 1990.

    Google Scholar 

  6. Sun Y, Gregersen H, Yuan W. Chinese health care system and clinical epidemiology. Clin Epidemiol. 2017. https://doi.org/10.2147/CLEP.S106258.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Writing Committee Expert Group. Diagnosis and treatment of pustular psoriasis: a Chinese expert consensus statement (2022). Chin J Dermatol. 2022. https://doi.org/10.35541/cjd.20210698.

    Article  Google Scholar 

  8. Augey F, Renaudier P, Nicolas JF. Generalized pustular psoriasis (Zumbusch): a French epidemiological survey. Eur J Dermatol. 2006. https://doi.org/10.1684/ejd.2006.0003.

    PubMed  Google Scholar 

  9. Baker H, Ryan TJ. Generalized pustular psoriasis: a clinical and epidemiological study of 104 cases. Br J Dermatol. 1968. https://doi.org/10.1111/j.1365-2133.1968.tb11947.x.

    Article  PubMed  Google Scholar 

  10. Noe MH, Wan MT, Mostaghimi A, et al. Evaluation of a case series of patients with generalized pustular psoriasis in the United States. JAMA Dermatol. 2022. https://doi.org/10.1001/jamadermatol.2021.4640.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Choon SE, Lai NM, Mohammad NA, et al. Clinical profile, morbidity, and outcome of adult-onset generalized pustular psoriasis: analysis of 102 cases seen in a tertiary hospital in Johor. Malaysia Int J Dermatol. 2014. https://doi.org/10.1111/ijd.12070.

    Article  PubMed  Google Scholar 

  12. Kharawala S, Golembesky AK, Bohn RL, et al. The clinical, humanistic, and economic burden of generalized pustular psoriasis: a structured review. Expert Rev Clin Immunol. 2020. https://doi.org/10.1080/1744666X.2019.1708193.

    Article  PubMed  Google Scholar 

  13. Zelickson BD, Muller SA. Generalized pustular psoriasis: a review of 63 cases. Arch Dermatol. 1991. https://doi.org/10.1001/archderm.127.9.1339.

    Article  CAS  PubMed  Google Scholar 

  14. Morita A, Kotowsky N, Gao R, et al. Patient characteristics and burden of disease in Japanese patients with generalized pustular psoriasis: results from the Medical Data Vision claims database. J Dermatol. 2021. https://doi.org/10.1111/1346-8138.16022.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hanna ML, Singer D, Valdecantos WC. Economic burden of generalized pustular psoriasis and palmoplantar pustulosis in the United States. Curr Med Res Opin. 2021. https://doi.org/10.1080/03007995.2021.1894108.

    Article  PubMed  Google Scholar 

  16. Reisner DV, Johnsson FD, Kotowsky N, et al. Impact of generalized pustular psoriasis from the perspective of people living with the condition: results of an online survey. Am J Clin Dermatol. 2022. https://doi.org/10.1007/s40257-021-00663-y.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gooderham MJ, Van Voorhees AS, Lebwohl MG. An update on generalized pustular psoriasis. Expert Rev Clin Immunol. 2019. https://doi.org/10.1080/1744666X.2019.1648209.

    Article  PubMed  Google Scholar 

  18. Maehara Lde S, Mariano MM, Góis AF, et al. Acute respiratory distress syndrome as a complication of generalized pustular psoriasis. An Bras Dermatol. 2011. https://doi.org/10.1590/s0365-05962011000300026.

    Article  PubMed  Google Scholar 

  19. Jin H, Cho HH, Kim WJ, et al. Clinical features and course of generalized pustular psoriasis in Korea. J Dermatol. 2015. https://doi.org/10.1111/1346-8138.12863.

    Article  PubMed  Google Scholar 

  20. Okubo Y, Kotowsky N, Gao R, et al. Clinical characteristics and health-care resource utilization in patients with generalized pustular psoriasis using real-world evidence from the Japanese Medical Data Center database. J Dermatol. 2021. https://doi.org/10.1111/1346-8138.16084.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Löfvendahl S, Norlin JM, Schmitt-Egenolf M. Economic burden of generalized pustular psoriasis in Sweden: a population-based register study. Psoriasis. 2022. https://doi.org/10.2147/PTT.S359011.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lu J, Shi Y. A review of disease burden and clinical management for generalized pustular psoriasis in China. Expert Rev Clin Immunol. 2022. https://doi.org/10.1080/1744666X.2022.2118716.

    Article  PubMed  Google Scholar 

  23. Ji S. A meta-analysis of the efficacy of cyclosporine A, methotrexate and acitretin in the treatment of generalized pustular psoriasis. J SDFMU SD Acad Med Sci. 2018. https://doi.org/10.3969/j.issn.1004-7115.2018.09.004.

    Article  Google Scholar 

  24. Misiak-Galazka M, Wolska H, Galazka A, et al. General characteristics and comorbidities in patients with palmoplantar pustulosis. Acta Dermatovenerol Croat. 2018.

    CAS  PubMed  Google Scholar 

  25. Brunasso AM, Massone C. Can we really separate palmoplantar pustulosis from psoriasis? J Eur Acad Dermatol Venereol. 2010. https://doi.org/10.1111/j.1468-3083.2010.03648.x.

    Article  PubMed  Google Scholar 

  26. Giménez-García R, Sánchez-Ramón S, Cuellar-Olmedo LA. Palmoplantar pustulosis: a clinicoepidemiological study. The relationship between tobacco use and thyroid function. J Eur Acad Dermatol Venereol. 2003. https://doi.org/10.1046/j.1468-3083.2003.00510.x.

    Article  PubMed  Google Scholar 

  27. Kim DH, Lee JY, Cho SI, et al. Risks of comorbidities in patients with palmoplantar pustulosis vs patients with psoriasis vulgaris or pompholyx in Korea. JAMA Dermatol. 2022. https://doi.org/10.1001/jamadermatol.2022.1081.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Trattner H, Blüml S, Steiner I, et al. Quality of life and comorbidities in palmoplantar pustulosis: a cross-sectional study on 102 patients. J Eur Acad Dermatol Venereol. 2017. https://doi.org/10.1111/jdv.14187.

    Article  PubMed  Google Scholar 

  29. Hu SC, Yuan SF, Chen GS, et al. Increased incidence of ischaemic heart disease and cerebrovascular disease in psoriasis patients with depression: a nationwide retrospective cohort study. J Eur Acad Dermatol Venereol. 2019. https://doi.org/10.1111/jdv.15616.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sarıkaya Solak S, Kara Polat A, Kilic S, et al. Clinical characteristics, quality of life and risk factors for severity in palmoplantar pustulosis: a cross-sectional, multicentre study of 263 patients. Clin Exp Dermatol. 2022. https://doi.org/10.1111/ced.14829.

    Article  PubMed  Google Scholar 

  31. Noe MH, Wan MT, Mostaghimi A, et al. Evaluation of a case series of patients with palmoplantar pustulosis in the United States. JAMA Dermatol. 2022. https://doi.org/10.1001/jamadermatol.2021.4635.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Misiak-Galazka M, Zozula J, Rudnicka L. Palmoplantar pustulosis: recent advances in etiopathogenesis and emerging treatments. Am J Clin Dermatol. 2020. https://doi.org/10.1007/s40257-020-00503-5.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Miyazaki C, Sruamsiri R, Mahlich J, et al. Treatment patterns and healthcare resource utilization in palmoplantar pustulosis patients in Japan: a claims database study. PLoS ONE. 2020. https://doi.org/10.1371/journal.pone.0232738.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Raposo I, Torres T. Palmoplantar psoriasis and palmoplantar pustulosis: current treatment and future prospects. Am J Clin Dermatol. 2016. https://doi.org/10.1007/s40257-016-0191-7.

    Article  PubMed  Google Scholar 

  35. Wang H, Jin H. Update on the aetiology and mechanisms of generalized pustular psoriasis. Eur J Dermatol. 2021. https://doi.org/10.1684/ejd.2021.4047.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Brunasso AM, Puntoni M, Aberer W, et al. Clinical and epidemiological comparison of patients affected by palmoplantar plaque psoriasis and palmoplantar pustulosis: a case series study. Br J Dermatol. 2013. https://doi.org/10.1111/bjd.12223.

    Article  PubMed  Google Scholar 

  37. Strober B, Kotowsky N, Medeiros R, et al. Unmet medical needs in the treatment and management of generalized pustular psoriasis flares: evidence from a Survey of Corrona Registry Dermatologists. Dermatol Ther (Heidelb). 2021. https://doi.org/10.1007/s13555-021-00493-0.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Bachelez H, Choon SE, Marrakchi S, et al. Inhibition of the interleukin-36 pathway for the treatment of generalized pustular psoriasis. N Engl J Med. 2019. https://doi.org/10.1056/NEJMc1811317.

    Article  PubMed  Google Scholar 

  39. Karmacharya P, Chakradhar R, Ogdie A. The epidemiology of psoriatic arthritis: a literature review. Best Pract Res Clin Rheumatol. 2021. https://doi.org/10.1016/j.berh.2021.101692.

    Article  PubMed  Google Scholar 

  40. Prinz JC, Choon SE, Griffiths CEM, et al. Prevalence, comorbidities and mortality of generalized pustular psoriasis: a literature review. J Eur Acad Dermatol Venereol. 2023. https://doi.org/10.1111/jdv.18720.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Our sincere gratitude to Mr. Lin Mei from the Beijing Municipal Health Big Data and Policy Research Center for his help in data acquisition and the interpretation of some data.

Author information

Authors and Affiliations

  1. Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (Dongdan campus), Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, No.1 Shuaifuyuan, Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China

    Hai-Meng Wang, Jia-Ming Xu & Hong-Zhong Jin

Authors
  1. Hai-Meng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jia-Ming Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hong-Zhong Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hong-Zhong Jin.

Ethics declarations

Funding

This study was supported in part by the CAMS Innovation Fund for Medical Sciences No. 2021-I2M-1-059, National High Level Hospital Clinical Research Funding (2022-PUMCH-B-092), and National Natural Science Foundation of China (82073450).

Conflicts of Interest/Competing Interests

Hai-Meng Wang, Jia-Ming Xu, and Hong-Zhong Jin have no conflicts of interest that are directly relevant to the content of this article.

Ethics Approval

This study was reviewed and approved by the Institutional Review Board of Peking Union Medical College Hospital; approval #JS-3434D.

Consent to Participate

The requirement for informed patient consent was waived because of the anonymous nature of the data.

Consent for Publication

The requirement for informed patient consent was waived because of the anonymous nature of the data.

Availability of Data and Material

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Code Availability

Not applicable.

Authors’ Contributions

HMW and HZJ provided the concept and design of the retrospective study. HMW was responsible for the data acquisition, data analysis, and interpretation. HMW and JMX provided the tables and figures in the article. HMW and JMX drafted the manuscript, which was supervised by HZJ. All authors gave their final approval of the version to be published.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, HM., Xu, JM. & Jin, HZ. Characteristics and Burdens of Disease in Patients from Beijing with Generalized Pustular Psoriasis and Palmoplantar Pustulosis: Multicenter Retrospective Cohort Study Using a Regional Database. Am J Clin Dermatol 24, 991–1002 (2023). https://doi.org/10.1007/s40257-023-00807-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-023-00807-2

Search

Navigation