Over the last few years, I have blogged about the enigmatic condition known as palmoplantar pustulosis (PPP). Originally thought to be palmoplantar psoriasis, recent studies have presented evidence of it being an entirely separate disease, based on its unique characteristics and non-response to common psoriatic treatments.
The condition PPP has many known associates - patients with PPP are known to be more likely to have conditions such as heart disease, hypertension, diabetes and depression as I discussed in an earlier post .
Smoking and Palmoplantar Pustulosis
One of the disease's peculiarities is the close association of it with tobacco use. Studies have consistently confirmed the unusually high proportions of patients who have [1-3] who have the disease, with data suggesting it is rare in patients who have never used tobacco.
A forthcoming study in the British Journal of Dermatology [4] has looked at the converse - and presented data reviewing the effect of smoking cessation on the progression of the condition. A report from Korea draws on health service data drawn from a database following reports from patient health checks in 5.7 million adults (from 2005 - 2007). The researchers draw data from patients with psoriasis, plantar psoriasis and PPP correlating it with the patients smoking status (never smoked, active smokers and quitters). Other confounding factors were taken into account with the analysis including age, gender, BMI, diabetes status and blood cholesterol.
In the examined cohort 52 306 (64% male) had psoriasis and 9785 (59% male) had PPP with average ages of 49 and 47 years respectively with similar mean BMI (23.8-23.9).
The data showed that for patients with psoriasis, continued smoking came with an increase in incidence with time, above that for ex-smokers (quitters) and those who never smoked. Quitters also showed a trend - slight increases in incidence for up to six years after smoking cessation whereupon the incidence was similar to non-smokers after that period.
For the PPP group, it was shown that quitting smoking, reduced the risk of developing PPP compared to continual smokers, with a rate similar to ex-smokers over time.
Does smoking cessation have an effect on the incidence of psoriasis and Palmo-plantar Pustulosis?
From the data presented here, it would suggest that smoking cessation will reduce the chances of an individual developing psoriasis or palmo-plantar pustulosis. However, the positive benefit of smoking cessation is much more significant in reducing PPP, than psoriasis. This may tie in with the theory that nicotine is a causative agent in the development of PPP. For further information on the aetiology of PPP, my published article can be downloaded in full here.
References
1. O'Doherty, C., The prevalence of cigarette smoking in patients with palmo-plantar pustulosis. Scott Med J, 1984. 29: p. 54.
2. O'Doherty, C.J. and C. MacIntyre, Palmoplantar pustulosis and smoking. Br Med J (Clin Res Ed), 1985. 291(6499): p. 861-4.
3. Miot, H., et al., Association between palmoplantar pustulosis and cigarette smoking in Brazil: a case-control study. J Eur Acad Dermatol Venereol, 2009. 23(10): p. 1173-1177.
4. Kim, S.R., Y.-G. Choi, and S.J. Jo, Effect of smoking cessation on psoriasis vulgaris, palmoplantar pustulosis, and generalized pustular psoriasis. British Journal of Dermatology, 2024 (in press).