Supplementary Tables. Psoriasis a

Transcription

1 Supplementary Tables Supplementary Table S1 Age-sex distribution of patients with psoriasis and PPP subdivided by the department specified in a claim with a diagnosis code of psoriasis and PPP in Japanese National Database Psoriasis a PPP Age Male Female Male Female (years old) N (%) N (%) N (%) N (%) All patients 0-9 3,376 (1.3) 3,177 (1.8) 396 (0.8) 382 (0.4) ,430 (1.7) 5,046 (2.9) 689 (1.5) 923 (1.0) ,800 (3.9) 9,904 (5.6) 1,821 (3.9) 3,673 (4.1) ,915 (11.0) 22,251 (12.6) 5,049 (10.7) 9,388 (10.6) ,637 (13.6) 21,588 (12.3) 7,256 (15.4) 13,237 (14.9) ,963 (17.7) 28,146 (16.0) 10,318 (21.8) 23,157 (26.0) ,510 (23.5) 33,907 (19.3) 12,384 (26.2) 23,021 (25.9) ,072 (18.9) 30,930 (17.6) 7,070 (15.0) 11,559 (13.0) 80-21,070 (8.3) 20,957 (11.9) 2,265 (4.8) 3,636 (4.1) Total 253,773 (100) 175,906 (100) 47,248 (100) 88,976 (100) Mean (SD) 57.1 (17.8) 56.1 (19.9) 55.7 (16.1) 55.5 (15.2) Patients of dermatology or rheumatology (subgroup A) b (1.0) 814 (1.6) 36 (0.4) 88 (0.3) ,137 (1.4) 1,278 (2.5) 70 (0.8) 110 (0.6) ,659 (3.3) 2,561 (5.0) 247 (2.7) 578 (3.2) ,677 (9.5) 5,582 (10.9) 828 (8.9) 1,567 (8.8) ,831 (12.1) 5,978 (11.7) 1,247 (13.4) 2,464 (13.8) ,674 (16.9) 8,607 (16.8) 1,946 (20.9) 4,777 (26.7) ,802 (25.7) 11,290 (22.0) 2,851 (30.6) 5,226 (29.2) ,355 (21.4) 9,840 (19.2) 1,638 (17.6) 2,493 (13.9) 80-6,975 (8.6) 5,319 (10.4) 442 (4.8) 623 (3.5) Total 80,920 (100) 51,269 (100) 9,305 (100) 17,890 (100) Mean (SD) 58.8 (17.1) 57.1 (19.0) 58.1 (14.8) 56.8 (14.1)

2 Supplementary Table S1 -- continued Psoriasis a PPP Age Male Female Male Female (years old) N (%) N (%) N (%) N (%) Patients of department other than dermatology or rheumatology (subgroup B) c (1.5) 232 (1.6) 53 (1.3) 30 (0.4) (1.1) 225 (1.6) 56 (1.3) 61 (0.7) (2.2) 476 (3.3) 110 (2.6) 265 (3.2) ,304 (6.8) 1,098 (7.6) 384 (9.2) 818 (9.9) ,889 (9.8) 1,380 (9.5) 600 (14.4) 1,091 (13.2) ,058 (15.9) 2,091 (14.4) 891 (21.4) 2,137 (25.9) ,797 (24.9) 3,091 (21.3) 1,165 (28.0) 2,238 (27.1) ,825 (25.1) 3,283 (22.6) 669 (16.1) 1,169 (14.2) 80-2,460 (12.8) 2,638 (18.2) 226 (5.4) 448 (5.4) Total 19,249 (100) 14,514 (100) 4,154 (100) 8,257 (100) Mean (SD) 61.7 (17.2) 61.9 (18.9) 56.8 (16.1) 56.9 (15.0) Patients of department not specified (subgroup C) d 0-9 2,278 (1.5) 2,131 (1.9) 307 (0.9) 300 (0.5) ,083 (2.0) 3,543 (3.2) 563 (1.7) 752 (1.2) ,723 (4.4) 6,867 (6.2) 1,464 (4.3) 2,830 (4.5) ,934 (12.3) 15,571 (14.1) 3,837 (11.4) 7,003 (11.1) ,917 (14.9) 14,230 (12.9) 5,409 (16.0) 9,682 (15.4) ,231 (18.4) 17,448 (15.8) 7,481 (22.1) 16,243 (25.9) ,911 (22.1) 19,526 (17.7) 8,368 (24.8) 15,557 (24.8) ,892 (16.9) 17,807 (16.2) 4,763 (14.1) 7,897 (12.6) 80-11,635 (7.6) 13,000 (11.8) 1,597 (4.7) 2,565 (4.1) Total 153,604 (100) 110,123 (100) 33,789 (100) 62,829 (100) Mean (SD) 55.6 (18.0) 54.9 (20.3) 54.9 (16.4) 54.9 (15.4)

3 Supplementary Table S1 -- continued a Patients with both of diagnosis codes of psoriasis and PPP are classified as those with psoriasis. b Patients with at least one claim with diagnosis code of psoriasis or PPP where the department was specified as dermatology or rheumatology during the 12-month observation period. c Patients with a diagnosis code of psoriasis or PPP where the department was specified as that other specialty but not as dermatology or rheumatology. d Patients with a diagnosis code of psoriasis or PPP where the department was not specified. PPP, palmoplantar pustulosis.

4 Supplementary Table S2 Diagnosis codes of psoriasis and PPP classified by the department specified in a claim in Japanese National Database Department All Specified Not patients Derma a Rheuma b Derma/ Other specified e rheuma c specialty d N f N f N f N f N f N f (%) (%) (%) (%) (%) (%) Psoriasis 130,953 2, ,189 33, , ,679 (100) (100) (100) (100) (100) (100) Plaque psoriasis 127,170 1, ,822 30, , ,705 (97.1) (69.6) (96.7) (96.5) (98.6) (97.4) Psoriasis vulgaris 103,573 1, ,002 20, , ,825 (79.1) (50.5) (78.7) (59.8) (81.4) (78.9) Psoriasis 20, ,231 11,159 44,821 77,302 (16.0) (22.9) (16.1) (33.1) (17.0) (18.0) Psoriasis vulgaris of entire body 7, , ,030 9,876 (5.5) (2.9) (5.5) (1.7) (0.8) (2.3) Psoriasis of extremities g (0.3) (0.3) (0.3) (0.2) (0.2) Psoriasis vulgaris of extremities 3, , ,417 6,002 (2.5) (1.0) (2.4) (1.1) (0.9) (1.4) Psoriasis vulgaris of lower back g (0.1) (0.1) (0.1) (0.03) (0.1) Plaque psoriasis g (0.1) (0.1) (0.03) (0.01) (0.03)

5 Supplementary Table S2 ---continued Department All Specified Not patients Derma a Rheuma b Derma/ Other specified e rheuma c specialty d N f N f N f N f N f N f (%) (%) (%) (%) (%) (%) Scalp psoriasis 1, g 1, ,395 2,832 (0.9) (0.9) (0.8) (0.5) (0.7) Seborrheic psoriasis h g (0.1) (0.1) (0.3) (0.1) (0.1) Psoriasis vulgaris of scalp 1, g 1, ,046 2,244 (0.8) (0.8) (0.4) (0.4) (0.5) Guttate psoriasis 1, g 1, ,193 2,572 (0.9) (0.9) (0.4) (0.5) (0.6) Psoriatic arthritis 3,774 1,210 4,530 2,128 1,702 8,360 (2.9) (52.6) (3.4) (6.3) (0.6) (1.9) Psoriatic arthritis 3, ,206 1,529 1,410 7,145 (2.8) (41.7) (3.2) (4.5) (0.5) (1.7) Psoriatic arthritis mutilans i ,139 (0.05) (10.6) (0.2) (1.7) (0.1) (0.3) Psoriatic spondylitis (0.1) (1.0) (0.1) (0.1) (0.01) (0.04) Pustular psoriasis 2, , ,274 4,636 (2.2) (2.9) (2.2) (1.2) (0.5) (1.1) Pustular psoriasis 2, , ,666 (2.0) (2.7) (2.0) (0.7) (0.3) (0.9) Impetigo herpetiformis j g (0.1) (0.1) (0.5) (0.1) (0.1)

6 Supplementary Table S2 ---continued Department All Specified Not patients Derma a Rheuma b Derma/ Other specified e rheuma c specialty d N f N f N f N f N f N f (%) (%) (%) (%) (%) (%) Acrodermatitis continua g (0.2) (0.2) (0.04) (0.1) (0.1) Generalized pustular psoriasis g g --- g 32 (0.02) (0.02) (0.01) Acute generalized pustular Psoriasis --- g --- g --- g --- g --- g --- g Erythrodermic psoriasis 1, , (0.8) (1.5) (0.8) (0.7) (0.1) (0.4) PPP 6, , ,620 12,625 (4.7) (3.6) (4.7) (2.4) (2.1) (2.9) PAO k (0.1) (0.9) (0.1) (0.2) (0.1) (0.1) PPP 26, ,195 12,411 96, ,224 (100) (100) (100) (100) (100) (100) PPP ,109 11,979 96, ,647 (99.8) (90.6) (99.7) (96.5) (99.9) (99.6) PAO l ,268 1,704 5,734 (2.6) (25.7) (2.8) (26.3) (1.8) (4.2)

7 Supplementary Table S2 -- continued a Patients with at least one claim with a diagnosis code of psoriasis or PPP where the department was specified as dermatology during the 12-month observation period. b Patients with at least one claim where the department was specified as rheumatology. c Patients with at least one claim where the department was specified as dermatology or rheumatology (department subgroup A). d Patients with any claim where the department was specified as other specialty but not dermatology or rheumatology (department subgroup B). e Patients with claims where the department was not specified (department subgroup C). f One patient is counted once for each code and for subclass of diagnosis and therefore sum of lower categories may exceed a total of upper category. g Less than 10 patients were found. h Internal medicine was specified for 68 (58%) of 118 patients with Seborrheic psoriasis in the department of other specialty. i Orthopedics was specified for 470 (82%) of 575 patients with Psoriatic arthritis mutilans in the department of other specialty. j Internal medicine was specified for 61 (38%) of 160 patients with Impetigo herpetiformis in the department of other specialty. k Internal medicine was specified for 54 (74%) of 73 patients with PAO in the department of other specialty under the broad disease category of psoriasis. l Internal medicine was specified for 2978 (91%) of 3268 patients with PAO in the department of other specialty under the broad disease category of PPP. PPP, palmoplantar pustulosis; PAO, pustulotic arthro-osteitis.

8 Supplementary Table S3 Use of healthcare service in each of 12 months during the study period in patients with psoriasis and PPP subdivided by the department in a claim with diagnosis code of psoriasis and PPP in Japanese National Database All Dermatology Other Department or rheumatology specialty not specified (subgroup A) (subgroup B) (subgroup C) Year and Month N b % N b % N b % N b % Patients with Psoriasis 2010 April 155, , , , May 157, , , , June 166, , , , July 168, , , , August 161, , , , September 162, , , , October 167, , , , November 168, , , , December 176, , , , January 164, , , , February 165, , , , March 177, , , , Total 429, , , ,

9 Supplementary Table S3 -- continued All Dermatology Other Department or rheumatology specialty not specified (subgroup A) (subgroup B) (subgroup C) Year and Month N b % N b % N b % N b % Patients with PPP 2010 April 41, , , , May 45, , , , June 52, , , , July 55, , , , August 52, , , , September 52, , , , October 52, , , , November 48, , , , December 49, , , , January 43, , , , February 44, , , , March 47, , , , Total 136, , , , a Patients with at least one claim with diagnosis code of psoriasis or PPP where the department was specified as either dermatology or rheumatology ( Dermatology or rheumatology ) or other specialty but not dermatology or rheumatology ( Other specialty ) during the 12-month observation period. b Number of patients with a claim with a diagnosis code of psoriasis or PPP. PPP, palmoplantar pustulosis.

10 Supplementary Table S4 Seasonal variation of use of healthcare service in patients with a diagnosis code of psoriasis and PPP in Japanese National Database Use of health-care service 2010 July 2011 January Psoriasis PPP or August or February N a % N a % All patients Yes Yes 147, , Yes No 78, , No Yes 80, , No No 123, , Total 429, , Difference (95% CI) b -0.33% (-0.51 to -0.15%) 10.0% (9.8 to 10.3%) P value c < Patients of dermatology or rheumatology (subgroup A) d Yes Yes 58, , Yes No 22, , No Yes 22, , No No 28, , Total 132, , Difference (95% CI) b 0.04% (-0.27 to 0.36%) 7.7% (7.1 to 8.4%) P value c 0.79 < Patients of department of other specialty (subgroup B) e Yes Yes 14, , Yes No 5, , No Yes 5, , No No 8, , Total 33, , Difference (95% CI) b 0.64% (0.03 to 1.25%) 6.6% (5.7 to 7.6%) P value c 0.04 <0.0001

11 Supplementary Table S4 --- continued Use of health-care service 2010 July 2011 January Psoriasis PPP or August or February N a % N a % Patients of department not specified (subgroup C) f Yes Yes 74, , Yes No 50, , No Yes 52, , No No 86, , Total 263, , Difference (95% CI) b -0.64% (-0.88 to -0.40%) 11.1% (10.8 to 11.5%) P value b < < a Number of patients with a claim with a diagnosis code of psoriasis or PPP. b Difference between the proportion of patients who used the healthcare service in the hottest season (July or August 2010) and the proportion of patients who used the service in the coldest season (January or February of 2011). c The result of paired t-test is shown. d Patients with at least one claim with diagnosis code of psoriasis or PPP where the department was specified as dermatology or rheumatology during the 12-month observation period. e Patients with a diagnosis code of psoriasis or PPP where the department was specified as other specialty but not as dermatology or rheumatology. f Patients with a diagnosis code of psoriasis or PPP where the department was not specified. PPP, palmoplantar pustulosis.

12 Supplementary Table S5 Treatments for psoriasis and PPP subdivided by the department specified in a claim with a diagnosis code of psoriasis and PPP in Japanese National Database Psoriasis PPP Psoriatic Male arthritis Male PAO N a N Age N N a N Age N (%) (%) (SD) (%) (%) (%) (SD) (%) All patients N=429,679 N=136,224 Systemic therapy Biologics 3,291 2, , (0.8) (64.8) (14.1) (33.8) (0.2) (25.7) (13.6) (7.9) Methotrexate 1,680 1, (0.4) (63.8) (15.5) (28.6) (0.1) (30.5) (13.4) (10.9) Ciclosporin 21,997 13, , (5.1) (62.8) (16.2) (7.3) (0.2) (39.0) (13.8) (8.0) Etretinate 15,481 11, , (3.6) (71.2) (13.6) (3.9) (1.4) (37.2) (11.7) (1.8) Phototherapy 21,005 12, ,408 3, (4.9) (58.9) (18.1) (1.5) (7.6) (35.1) (15.0) (1.5) Topical therapy Topical vitamin D 256, , ,698 42,903 14, (59.6) (60.9) (18.5) (1.4) (31.5) (33.3) (14.9) (1.4) Topical corticosteroid349, , , ,692 37, ,576 (81.4) (60.6) (18.1) (1.5) (80.5) (34.5) (15.3) (3.3) No treatment 38,224 19, ,851 21,209 7, ,083 (8.9) (50.7) (19.5) (4.8) (15.6) (35.5) (16.2) (9.8)

13 Supplementary Table S5 --- continued Psoriasis PPP Psoriatic Male arthritis Male PAO N a N Age N N a N Age N (%) (%) (SD) (%) (%) (%) (SD) (%) Patients of dermatology or rheumatology (subgroup A) b N=132,189 N=27,195 Systemic therapy Biologics 2,674 1, c (2.0) (68.3) (13.8) (33.5) (0.4) (25.0) (11.9) Methotrexate (0.5) (64.0) (15.6) (41.1) (0.2) (20.9) (13.0) (19.4) Ciclosporin 12,330 7, , c (9.3) (64.2) (15.8) (8.3) (0.4) (33.9) (11.9) Etretinate 9,010 6, (6.8) (70.9) (13.5) (5.6) (2.7) (36.4) (10.7) (3.5) Phototherapy 5,465 3, , (4.1) (61.3) (16.9) (3.3) (5.6) (32.6) (14.2) (2.8) Topical therapy Topical vitamin D 86,201 54, ,736 11,194 3, (65.2) (63.6) (17.7) (3.2) (41.2) (33.4) (14.0) (3.3) Topical corticosteroid112,813 70, ,580 23,415 8, (85.3) (62.6) (17.3) (3.2) (86.1) (34.2) (14.3) (2.7) No treatment 7,621 3, , (5.8) (50.0) (19.7) (5.9) (10.0) (34.4) (14.5) (4.2)

14 Supplementary Table S5 --- continued Psoriasis PPP Psoriatic Male arthritis Male PAO N a N Age N N a N Age N (%) (%) (SD) (%) (%) (%) (SD) (%) Patients of department other specialty (subgroup B) d N=33,763 N=12,411 Systemic therapy Biologics (0.9) (55.4) (15.0) (52.7) (0.4) (23.5) (11.8) (21.6) Methotrexate c (0.8) (55.1) (16.3) (50.2) (0.3) (39.5) (11.9) Ciclosporin 2,474 1, (7.3) (50.4) (16.0) (14.1) (0.3) (34.2) (16.2) (26.3) Etretinate c (1.9) (71.1) (13.5) (4.2) (0.6) (29.2) (11.8) Phototherapy (2.0) (60.2) (16.7) (5.2) (3.1) (35.0) (14.8) (19.2) Topical therapy Topical vitamin D 11,608 7, , (34.4) (63.6) (17.3) (3.4) (14.8) (31.6) (14.7) (8.4) Topical corticosteroid 19,804 12, ,037 2, ,858 (58.7) (60.6) (18.4) (4.4) (56.7) (32.7) (15.7) (26.4) No treatment 9,906 5, ,005 1, ,391 (29.3) (51.7) (17.0) (9.3) (40.3) (34.7) (14.9) (27.8)

15 Supplementary Table S5 --- continued Psoriasis PPP Psoriatic Male arthritis Male PAO N a N Age N N a N Age N (%) (%) (SD) (%) (%) (%) (SD) (%) Patients of department not specified (subgroup C) e N=263,727 N=96,618 Systemic therapy Biologics c (0.1) (44.0) (15.0) (18.9) (0.1) (27.8) (16.3) Methotrexate c (0.3) (66.8) (15.0) (9.1) (0.1) (34.8) (14.3) Ciclosporin 7,193 4, c (2.7) (64.6) (16.7) (3.2) (0.1) (46.2) (14.5) Etretinate 5,821 4, , c (2.2) (71.7) (13.6) (1.4) (1.2) (38.2) (12.4) Phototherapy 14,851 8, ,493 3, (5.6) (57.9) (18.5) (0.6) (8.8) (35.6) (15.1) (0.5) Topical therapy Topical vitamin D 158,313 93, ,877 9, (60.0) (59.3) (18.8) (0.4) (30.9) (33.3) (15.1) (0.3) Topical corticosteroid216, , ,240 27, ,095 (82.3) (59.5) (18.3) (0.4) (82.0) (34.8) (15.4) (1.4) No treatment 20,697 10, ,472 4, (7.8) (50.6) (20.3) (2.3) (13.9) (36.0) (16.9) (4.3)

16 Supplementary Table S5 -- continued a One patient is counted once for each treatment. b Patients with at least one claim with a diagnosis code of psoriasis or PPP where the department was specified as dermatology or rheumatology during the 12-month observation period. c Less than 10 patients had the treatment. d Patients with a diagnosis code of psoriasis or PPP where the department was specified as other specialty but not as dermatology or rheumatology. e Patients with a diagnosis code of psoriasis or PPP where the department was not specified. PPP, palmoplantar pustulosis; PAO, pustulotic arthro-osteitis.

17 Supplementary Table S6 Prevalence of diabetes mellitus, hyperlipidemia and hypertension in severity classes I to IV of patients with psoriasis and PPP subdivided by the department specified in the claim in Japanese National Database All patients Patients of Patients of Patients of Severity Class I (systemic therapy) dermatol or rheumatol a other department b department not specified c (subgroup A) (subgroup B) (subgroup C) Psoriasis PPP Psoriasis PPP Psoriasis PPP Psoriasis PPP Total N 39,796 2,588 22,641 1,009 3, ,635 1,385 Diabetes mellitus N d 5, , , Prevalence e (%) Difference f (%) (95%CI) (2.7,3.4) (-0.5,2.1) (1.6,2.5) (-1.4,3.9) (4.5,7.1) (-5.8,4.6) (0.9,1.9) (-1.1,1.8) Hyperlipidemia N d 8, , , , Prevalence e (%) Difference f (%) (95%CI) (2.8,3.6) (-0.6,2.6) (1.9,3.1) (-0.9,5.0) (4.8,7.7) (-8.2,2.8) (0.8,2.1) (-1.5,2.4) Hypertension N d 11, , , , Prevalence e (%) Difference f (%) (95%CI) (4.7,5.6) (-1.0,2.3) (5.3,6.6) (-3.0,3.0) (1.9,4.9) (-11.9,0.5) (0.8,2.2) (-1.0,3.2)

18 Supplementary Table S6 -- continued All patients Patients of Patients of Patients of dermatol or rheumatol a other department b department not specified c (subgroup A) (subgroup B) (subgroup C) Psoriasis PPP Psoriasis PPP Psoriasis PPP Psoriasis PPP Severity Class II (phototherapy without systemic therapy) Total N 18,833 10,153 4,332 1, ,887 8,322 Diabetes mellitus N d 1, , Prevalence e (%) Difference f (%) (95%CI) (-1.0,-0.2) (-1.4,-0.2) (1.6,2.5) (-1.4,3.9) (-4.1,0.8) (-4.9,1.3) (-0.6,0.3) (-0.9,0.5) Hyperlipidemia N d 3,125 1, ,183 1,392 Prevalence e (%) Difference f (%) (95%CI) (-1.3,-0.3) (-0.7,1.0) (1.9,3.1) (-0.9,5.0) (-3.9,1.9) (-5.0,2.8) (-1.2,0.0) (-0.6,1.2) Hypertension N d 4,369 1,885 1, ,004 1,511 Prevalence e (%) Difference f (%) (95%CI) (-1.2,-0.1) (-0.9,0.9) (5.3,6.6) (-3.0,3.0) (-6.6,-0.9) (-5.2,3.2) (-1.1,0.2) (-0.7,1.2)

19 Supplementary Table 6 -- continued All patients Patients of Patients of Patients of dermatol or rheumatol a other department b department not specified c (subgroup A) (subgroup B) (subgroup C) Psoriasis PPP Psoriasis PPP Psoriasis PPP Psoriasis PPP Severity Class III (topical therapy only) Total N 332, ,274 97,595 22,002 19,723 6, ,508 73,439 Diabetes mellitus N d 32,378 7,583 11,886 2,141 2, ,507 4,717 Prevalence e (%) Difference f (%) ref ref ref ref ref ref ref ref Hyperlipidemia N d 56,561 17,783 19,006 4,434 4,206 1,315 33,289 12,034 Prevalence e (%) Difference f (%) ref ref ref ref ref ref ref ref Hypertension N d 78,996 19,322 26,307 4,781 6,484 1,548 46,205 12,993 Prevalence e (%) Difference f (%) ref ref ref ref ref ref ref ref

20 Supplementary Table S6 -- continued All patients Patients of Patients of Patients of dermatol or rheumatol a other department b department not specified c (subgroup A) (subgroup B) (subgroup C) Psoriasis PPP Psoriasis PPP Psoriasis PPP Psoriasis PPP Severity Class IV (No treatment) Total N 38,224 21,209 7,621 2,732 9,906 5,005 20,697 13,472 Diabetes mellitus N d 4,669 2, , ,185 1,178 Prevalence e (%) Difference f (%) (95%CI) (1.6,2.2) (1.5,2.4) (-1.3,0.1) (-1.2,1.5) (0.6,2.4) (0.2,2.8) (1.0,1.8) (1.2,2.3) Hyperlipidemia N d 7,771 4,283 1, ,340 1,087 4,113 2,660 Prevalence e (%) Difference f (%) (95%CI) (1.0,1.8) (0.8,2.0) (-2.8,-1.1) (-2.0,1.1) (0.1,1.9) (-0.9,2.1) (1.4,2.4) (0.8,2.2) Hypertension N d 11,061 4,786 1, ,547 1,293 5,839 2,921 Prevalence e (%) Difference f (%) (95%CI) (1.7,2.6) (1.5,2.8) (-4.3,-2.5) (-2.6,0.9) (0.2,2.2) (-0.6,2.5) (1.7,2.8) (1.2,2.8)

21 Supplementary Table S6 -- continued a Patients with at least one claim with a diagnosis code of psoriasis or PPP where the department was specified as dermatology or rheumatology during the 12-month observation period. b Patients with a diagnosis code of psoriasis or PPP where the department was specified as other specialty but not as dermatology or rheumatology. c Patients with diagnosis code of psoriasis or PPP where the department was not specified. d Number of patients with a diagnosis code of the concurrent disease (diabetes mellitus, hyperlipidemia or hypertension) at least in one claim as well as a drug to treat the concurrent disease in the claims issued in 2 or more different months. e Prevalence was standardized to the distribution of age and sex in the entire study population of 565,903 subjects as in Table 4 in the text. f Difference of the standardized prevalence between the severity classes I, II and IV and the severity class III (topical treatment only) in each department subgroup. PPP, palmoplantar pustulosis; CI, confidence interval.