Serizawa Naotaka, Okazaki Shizuka, Otsuka Yohei, Koto Mototaka, Okabe Kyochika, Ito Michiko, Morita Takashi, Hoashi Toshihiko, Saeki Hidehisa, Abe Namiko, Mori Miho, Okubo Yukari, Yano Yumiko, Mitsui Hiroshi, Kanda Naoko
Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan.
Department of Dermatology, Nippon Medical School, Bunkyo-Ku, Tokyo, Japan.
J Dermatol. 2021 Mar;48(3):366-375. doi: 10.1111/1346-8138.15719. Epub 2021 Jan 6.
Palmoplantar pustulosis (PPP) is a chronic dermatitis characterized by sterile intra-epidermal pustules associated with erythema and scales on the palms and soles. Tumor necrosis factor (TNF)-α/interleukin (IL)-23/IL-17 inflammatory pathway may be involved in the pathogenesis of PPP, and the skin lesions manifest the enhanced expression of IL-8 in keratinocytes and increased levels of antimicrobial peptide cathelicidin, leucine leucine-37 in vesicles/pustules. Some PPP patients are associated with arthro-osteitis, called pustulotic arthro-osteitis (PAO). Dietary habits may modulate the pathogenesis of PPP, however, have not been investigated in PPP patients. We evaluated dietary habits in adult Japanese PPP patients, using a validated, brief-type self-administered diet history questionnaire, and compared their results to those of age- and sex-matched healthy controls. The results in PPP patients with PAO were compared to those in the patients without. Japanese PPP patients showed higher body mass indices (BMIs), higher intakes of pulses and sugar/sweeteners, and lower intake of vitamin A, compared to those of healthy controls. The bivariate and multivariable logistic regression analysis showed that PPP was associated with high BMI, high intake of pulses, and low intake of vitamin A. The sodium intake and BMI were positively correlated with palmoplantar pustulosis area and severity index (PPPASI). The linear multivariate regression analysis revealed that sodium intake and BMI were predictors of PPPASI. The age and sodium intake in the patients with PAO were lower than those in the patients without. The bivariate and multivariable logistic regression analysis showed that PAO was negatively associated with age and sodium intake. This is the first study showing the dietary habits in patients with PPP. Further studies should clarify if the dietary intervention to correct the BMI and sodium intake will alter the progress of PPP.
掌跖脓疱病（PPP）是一种慢性皮炎，其特征为表皮内无菌性脓疱，并伴有手掌和脚底的红斑及鳞屑。肿瘤坏死因子（TNF）-α/白细胞介素（IL）-23/IL-17炎症通路可能参与了PPP的发病机制，皮肤病变表现为角质形成细胞中IL-8表达增强，以及水疱/脓疱中抗菌肽cathelicidin、亮氨酸亮氨酸-37水平升高。一些PPP患者伴有关节骨炎，称为脓疱性关节骨炎（PAO）。饮食习惯可能会调节PPP的发病机制，然而，尚未在PPP患者中进行研究。我们使用经过验证的简短型自我管理饮食史问卷评估了成年日本PPP患者的饮食习惯，并将其结果与年龄和性别匹配的健康对照者的结果进行比较。将患有PAO的PPP患者的结果与未患PAO的患者的结果进行比较。与健康对照者相比，日本PPP患者的体重指数（BMI）更高，豆类和糖/甜味剂的摄入量更高，而维生素A的摄入量更低。双变量和多变量逻辑回归分析表明，PPP与高BMI、豆类高摄入量和维生素A低摄入量相关。钠摄入量和BMI与掌跖脓疱病面积和严重程度指数（PPPASI）呈正相关。线性多变量回归分析显示，钠摄入量和BMI是PPPASI的预测指标。患有PAO的患者的年龄和钠摄入量低于未患PAO的患者。双变量和多变量逻辑回归分析表明，PAO与年龄和钠摄入量呈负相关。这是第一项展示PPP患者饮食习惯的研究。进一步的研究应阐明纠正BMI和钠摄入量的饮食干预是否会改变PPP的病程。
