title: Women with palmoplantar pustulosis have disturbed calcium homeostasis and a high prevalence of diabetes mellitus and psychiatric disorders: a case-control study.
abstract: Palmoplantar pustulosis is characterized by pustule formation in the acrosyringium. Nearly 50% of palmoplantar pustulosis sera produce immunofluorescence of the palmar papillary endothelium from healthy subjects, but also of the endothelium of normal parathyroid gland. With a case-control design the levels of calcium and parathyroid hormone in serum were measured in 60 women with palmoplantar pustulosis and 154 randomly selected population-based control women. One-third of the controls had been smokers, whereas 95% of the cases were or had been smokers. Mean age-adjusted serum calcium was increased in the patients compared with the controls (2.43 vs 2.36 mmol/l; p<0.0001), whereas the parathyroid hormone concentration was suppressed (23.2 vs 31.1 ng/l; p<0.0001). The plasma levels of parathyroid hormone-related protein were normal in patients but there was a strong expression of this protein in the acrosyringium both in palmoplantar pustulosis and control skin. As even a marginal elevation of serum calcium is associated with an increased risk for diabetes, cardiovascular disease and psychiatric disease, we analysed the risk for these disorders in palmoplantar pustulosis patients compared with that in the control group. Both diabetes mellitus and psychiatric disorders were associated with palmoplantar pustulosis with an odds ratio of 8.7 (95% CI 3.3-22.8) and 5.6 (95% CI 2.2-14.4), respectively. Palmoplantar pustulosis is a complex disease with an increased risk for several non-dermatological disorders. The role of the mildly increased serum calcium for the high risk for diabetes and depression deserves to be studied.
authors.affiliation: Department of Medical Sciences/Dermatology, University Hospital, S-751 85 Uppsala, Sweden. eva.hagforsen@medsci.uu.se
authors.forename: Eva
authors.initials: E
authors.lastname: Hagforsen
authors.forename: Karl
authors.initials: K
authors.lastname: Michaëlsson
authors.forename: Ewa
authors.initials: E
authors.lastname: Lundgren
authors.forename: Helena
authors.initials: H
authors.lastname: Olofsson
authors.forename: Axel
authors.initials: A
authors.lastname: Petersson
authors.forename: Alena
authors.initials: A
authors.lastname: Lagumdzija
authors.forename: Håkan
authors.initials: H
authors.lastname: Hedstrand
authors.forename: Gerd
authors.initials: G
authors.lastname: Michaëlsson
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood*; D016022:Case-Control Studies; D003920:Diabetes Mellitus; D005260:Female; D006706:Homeostasis; D006801:Humans; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D044162:Parathyroid Hormone-Related Protein / Q000097:blood / Q000378:metabolism*; D015995:Prevalence; D011565:Psoriasis / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000378:metabolism*; D013548:Sweden / Q000453:epidemiology
chemical_list: D044162:Parathyroid Hormone-Related Protein; D002118:Calcium