Kim Minsu, Yang Seungkeol, Kim Bo Ri, Youn Sang Woong
Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.
J Dermatol. 2021 Mar;48(3):360-365. doi: 10.1111/1346-8138.15716. Epub 2020 Dec 11.
Pathogenesis of palmoplantar pustulosis (PPP) is not fully understood and whether PPP is a variant of plaque psoriasis (PsO) is still controversial. Psoriatic nail changes are among the clinical features common to both diseases, and understanding them could lead to the understanding of the correlation between both diseases. However, only limited numbers of studies have reported nail involvement pattern in PPP. In this study, we conducted a retrospective review of the medical records and photographs of patients diagnosed with PPP to understand the nail involvement features in PPP patients. We compared the results with the data from our previous study that analyzed the pattern of nail involvement in PsO. As a result, nail involvement was observed in 66.3% of the patients and its severity was correlated with the severity of cutaneous lesions (r = 0.34, P = 0.01). Onycholysis and crumbling were more frequent in PPP than in PsO. Crumbling was associated with higher severity of PPP (P = 0.01), while onycholysis was associated with lower severity (P = 0.03). In PPP, nail changes in the first digits were less prominent than those in other digits when compared with PsO. Risk factors for nail involvement in PPP included female sex (odds ratio [OR] = 9.44, P < 0.001), younger age at diagnosis (OR = 1.08, P = 0.01), and higher severity (OR = 1.15, P = 0.01). Presence of psoriatic arthritis did not show significant association with nail involvement (OR = 1.62, P = 0.77). In conclusion, although PPP shares some nail features with PsO, differences were noted in the commonly observed features and in the distribution of involved nails.
掌跖脓疱病（PPP）的发病机制尚未完全明确，且PPP是否为斑块状银屑病（PsO）的一种变体仍存在争议。银屑病甲改变是这两种疾病共有的临床特征之一，了解这些改变有助于理解两种疾病之间的关联。然而，仅有少数研究报道了PPP的甲受累模式。在本研究中，我们对诊断为PPP的患者的病历和照片进行了回顾性分析，以了解PPP患者的甲受累特征。我们将结果与之前分析PsO甲受累模式的研究数据进行了比较。结果显示，66.3%的患者出现甲受累，其严重程度与皮肤病变的严重程度相关（r = 0.34，P = 0.01）。PPP患者的甲剥离和甲破碎比PsO患者更常见。甲破碎与PPP的较高严重程度相关（P = 0.01），而甲剥离与较低严重程度相关（P = 0.03）。与PsO相比，PPP患者中，拇指的甲改变不如其他手指明显。PPP甲受累的危险因素包括女性（优势比[OR]=9.44，P<0.001）、诊断时年龄较小（OR = 1.08，P = 0.01）和较高的严重程度（OR = 1.15，P = 0.01）。银屑病关节炎的存在与甲受累无显著关联（OR = 1.62，P = 0.77）。总之，尽管PPP与PsO有一些甲特征相同，但在常见特征和受累指甲的分布方面存在差异。
