SLR - January 2012 - Kelly Heppert
Reference: Farley, E., Masrour, S., McKey, J., Menter A. (2009). Palmoplantar Psoriasis: A Phenotypical and Clinical Review with Introduction of a New Quality-of-Life Assessment Tool. Journal of the American Academy of Dermatology 60(6)
Scientific Literature Review
Reviewed by: Kelly Heppert, DPM
Residency Program: Botsford Hospital
Podiatric Relevance:
Psoriasis on the plantar surface of the feet is often difficult to treat and sometimes difficult to distinguish from other dermatopathologies. Morphologic differentiation may lead to better focused treatment options. As we move into an outcome based payment system, it becomes increasingly important to have assessment tools to gauge treatment progress for reimbursement purposes. This study offers a new quality assessment tool that may prove valuable in the evaluation of treatment efficacy of psoriasis in podiatric offices.
Methods:
This is a retrospective study of 150 patients with palmopustular psoriasis identified in a single clinic in Dallas, TX, including evaluation of 900 patients on systemic therapy. Significant palmopustular psoriasis was defined as moderate to severe psoriasis involving >50% of a single palm or plantar surface. The majority of examinations were performed by a single investigator. The quality of life measures were given by one of 4 people. Descriptive statistics were used to summarize data on patient age, sex, family history, nail involvement, disease duration, lesion morphology, treatment, and response to treatment at 3-month intervals. All 150 patients received the quality of life assessment questionnaire.
Results:
Lesion morphology was as follows: Hyperkeratotic variety 52%, Pustular variety 16%, Mixed variety 12%, Indeterminate 20%. Only 18% of patients had involvement of only the palms and soles.
As determined through use of the new quality of life assessment questionnaire, 34% were severely affected, 48% were moderately affected, and 18% only mildly affected by their disease.
Family involvement occurred in 23% of patients, 60% had psoriatic nail changes, and 95% had at some point failed topical treatment, which required them to undergo systemic therapy. Acitretin was used most commonly (76%), followed by tumor necrosis factor inhibitory agents (10%), methotrexate (7%), and efalizumab (5%).
Conclusions:
The use of phenotyping along with the new quality of life assessment may lead to an easy way for physicians to quantitatively evaluate palmoplantar psoriatic disease severity. This tool has yet to be independently validated, but should provide useful information to help in the treatment of this disease and lead to evidence based medical treatment plans based on phenotyping.