What are the main symptoms of palmoplantar psoriasis. How does this condition affect the hands and feet. What treatment options are available for managing palmoplantar psoriasis. Are there any risk factors or complications associated with this form of psoriasis.

Understanding Palmoplantar Psoriasis: A Comprehensive Overview

Palmoplantar psoriasis is a specific form of psoriasis that primarily affects the palms of the hands and soles of the feet. This chronic inflammatory skin condition can significantly impact a person’s quality of life due to its location on areas frequently used in daily activities. While it shares similarities with other types of psoriasis, palmoplantar psoriasis presents unique challenges and requires specialized treatment approaches.

Prevalence and Demographics

Research indicates that psoriasis affects approximately 2-5% of the general population. Among individuals with psoriasis, about 3-4% develop palmoplantar psoriasis. This condition can occur at any age, although a related condition called palmoplantar pustulosis typically manifests between the ages of 20 and 60 years.

Genetic and Environmental Factors

While the exact cause of palmoplantar psoriasis remains unknown, experts believe it results from a combination of genetic predisposition and environmental triggers. Some studies suggest that certain sweat glands may play a role in the development of this condition. It’s important to note that palmoplantar psoriasis is not contagious, as it is an autoimmune disorder rather than an infectious disease.

Recognizing the Symptoms of Palmoplantar Psoriasis

Palmoplantar psoriasis manifests with distinct symptoms that can vary in severity and presentation. Identifying these symptoms is crucial for early diagnosis and effective management of the condition.

Key Symptoms

• Well-defined areas of raised, thickened skin
• Scaling and flaking of affected areas
• Intense itching and burning sensations
• Pain and discomfort
• Cracking and bleeding of the skin
• Small pustules in some cases
• Nail changes, including pitting, ridging, and thickening

In many cases, the symptoms appear symmetrically, affecting both hands or both feet in similar patterns. The condition can make everyday activities challenging, particularly those involving the use of hands or walking.

Palmoplantar Psoriasis on Skin of Color

Symptoms may present differently on skin of color. Instead of the typical pink appearance, plaques may be thicker and have a more silvery appearance. Some plaques might look purple, and affected individuals may experience hyperpigmentation or hypopigmentation in the surrounding areas. While palmoplantar psoriasis is more common in white populations, it tends to affect people of Indian descent more frequently among People of Color.

Differentiating Palmoplantar Psoriasis from Other Skin Conditions

Accurately diagnosing palmoplantar psoriasis is essential for appropriate treatment. However, its symptoms can sometimes be confused with other skin conditions affecting the hands and feet.

Palmoplantar Pustulosis

Palmoplantar pustulosis is genetically similar to palmoplantar psoriasis but presents with clusters of white pustules alongside the characteristic plaques. This distinction is important for determining the most effective treatment approach.

Other Similar Conditions

Conditions that may mimic palmoplantar psoriasis include:

• Eczema
• Contact dermatitis
• Fungal infections
• Hand-foot syndrome

A dermatologist can perform a thorough examination and potentially a skin biopsy to confirm the diagnosis of palmoplantar psoriasis and rule out other conditions.

The Impact of Palmoplantar Psoriasis on Daily Life

Palmoplantar psoriasis can significantly affect a person’s quality of life due to its location on the hands and feet. The condition can interfere with various aspects of daily living and social interactions.

Functional Limitations

People with palmoplantar psoriasis may experience difficulty with:

• Walking or standing for extended periods
• Gripping objects or performing fine motor tasks
• Wearing certain types of shoes or gloves
• Participating in sports or physical activities

Psychological and Social Impact

The visible nature of palmoplantar psoriasis can lead to psychological distress and social challenges, including:

• Embarrassment and self-consciousness
• Anxiety in social situations
• Difficulty in maintaining personal and professional relationships
• Reduced self-esteem and body image concerns

Can palmoplantar psoriasis be considered a disability? In some cases, yes. With proper medical documentation, individuals with severe palmoplantar psoriasis may qualify for social security disability payments. The condition’s impact on hand and foot function can significantly impair a person’s ability to work and perform daily tasks.

Treatment Options for Palmoplantar Psoriasis

Managing palmoplantar psoriasis often requires a combination of treatments tailored to the individual’s symptoms and severity. The goal is to reduce inflammation, alleviate symptoms, and improve quality of life.

Topical Treatments

First-line treatments for mild to moderate cases typically include:

• Corticosteroid creams or ointments
• Vitamin D analogs
• Retinoids
• Tar-based products
• Salicylic acid

Systemic Medications

For more severe cases or those unresponsive to topical treatments, systemic medications may be prescribed:

• Oral retinoids
• Methotrexate
• Cyclosporine
• Biologics (such as TNF-alpha inhibitors or IL-17 inhibitors)

Phototherapy

Controlled exposure to ultraviolet light, either UVB or PUVA (psoralen plus UVA), can help reduce symptoms in some cases.

Complementary Therapies

Additional treatments that may provide relief include:

• Moisturizers and emollients
• Occlusion therapy
• Stress reduction techniques
• Dietary modifications

What is the most effective treatment for palmoplantar psoriasis? The most effective treatment varies from person to person. A combination of topical treatments, systemic medications, and lifestyle modifications often yields the best results. Working closely with a dermatologist to develop a personalized treatment plan is crucial for optimal management of the condition.

Managing Flares and Preventing Recurrence

Palmoplantar psoriasis is characterized by periods of remission and flare-ups. Understanding triggers and implementing preventive strategies can help manage the condition more effectively.

Identifying Triggers

Common triggers for palmoplantar psoriasis flares include:

• Stress
• Skin injuries or trauma
• Certain medications
• Infections
• Weather changes
• Alcohol consumption
• Smoking

Preventive Measures

To reduce the frequency and severity of flares, individuals can:

• Maintain a consistent skincare routine
• Avoid harsh soaps and irritating chemicals
• Use protective gloves and comfortable, breathable footwear
• Manage stress through relaxation techniques or counseling
• Avoid known triggers
• Stay hydrated and maintain a balanced diet
• Quit smoking and limit alcohol intake

How can one effectively manage palmoplantar psoriasis flares? Prompt treatment at the first sign of a flare, adherence to prescribed medications, and consistent implementation of preventive measures are key to managing flares effectively. Regular follow-ups with a dermatologist can help adjust treatment plans as needed.

Living with Palmoplantar Psoriasis: Coping Strategies and Support

Coping with palmoplantar psoriasis extends beyond medical treatment. Developing effective strategies to manage the physical and emotional aspects of the condition is crucial for overall well-being.

Emotional Well-being

Strategies to maintain emotional health include:

• Seeking support from friends, family, or support groups
• Practicing mindfulness and stress-reduction techniques
• Considering counseling or therapy to address anxiety or depression
• Educating others about the condition to reduce stigma

Lifestyle Adaptations

Practical adjustments can help manage symptoms and improve quality of life:

• Using adaptive tools for daily tasks
• Modifying work environments or duties when necessary
• Exploring gentle exercises that don’t exacerbate symptoms
• Developing a skincare routine that works with individual needs

Building a Support Network

Creating a strong support system is invaluable for individuals with palmoplantar psoriasis. This can include:

• Joining psoriasis support groups or online communities
• Partnering with healthcare providers for comprehensive care
• Involving family and friends in understanding and managing the condition
• Connecting with patient advocacy organizations for resources and support

How can individuals with palmoplantar psoriasis maintain a positive outlook? Focusing on self-care, setting realistic goals, celebrating small victories, and maintaining open communication with healthcare providers and loved ones can help foster a positive mindset. Remember that managing palmoplantar psoriasis is a journey, and improvement is possible with persistence and the right support.

Advances in Palmoplantar Psoriasis Research and Future Treatments

The field of palmoplantar psoriasis research is continually evolving, with new insights into the condition’s underlying mechanisms and potential treatments emerging regularly.

Current Research Focus

Ongoing research areas include:

• Genetic factors contributing to palmoplantar psoriasis
• The role of the immune system in disease progression
• Novel targeted therapies with fewer side effects
• Personalized medicine approaches for more effective treatment

Promising Treatment Developments

Emerging treatments and approaches under investigation include:

• New biologics targeting specific inflammatory pathways
• Topical formulations with enhanced penetration and efficacy
• Combination therapies for improved outcomes
• Gene therapy and immunomodulatory techniques

What advancements can we expect in palmoplantar psoriasis treatment in the coming years? While it’s difficult to predict specific breakthroughs, the trend towards more targeted, personalized treatments is likely to continue. Improved understanding of the condition’s genetic and immunological basis may lead to more effective therapies with fewer side effects.

As research progresses, individuals with palmoplantar psoriasis can remain hopeful about the potential for new and improved treatment options. Staying informed about the latest developments and discussing emerging therapies with healthcare providers can help patients access the most current and effective treatments available.

In conclusion, palmoplantar psoriasis presents unique challenges due to its location and impact on daily activities. However, with proper diagnosis, tailored treatment plans, and effective coping strategies, individuals can successfully manage the condition and maintain a good quality of life. Ongoing research and advancements in treatment options offer hope for even better outcomes in the future. By working closely with healthcare providers and leveraging available support resources, those affected by palmoplantar psoriasis can navigate the challenges of the condition and look forward to continued improvements in care and management strategies.

Palmoplantar Psoriasis: Causes, Symptoms, Risks, Treatment

Palmoplantar psoriasis is a form of psoriasis that affects the palms of the hands and the soles of the feet. It causes areas of raised, thickened, and discolored skin and can lead to pain, bleeding, and skin cracking.

Palmoplantar psoriasis is psoriasis on the hands, although it can appear almost anywhere on the body, including the feet. The condition is a subtype of both plaque psoriasis and pustular psoriasis, depending on how it manifests.

According to research, psoriasis affects 2–5% of the population, and 3–4% of individuals with psoriasis have palmoplantar psoriasis. Palmoplantar psoriasis can occur at any age. A related condition, palmoplantar pustulosis, usually starts between the ages of 20 and 60 years.

A person may not have symptoms all the time. Often, they will experience times of remission and then a flare. Certain triggers can cause a flare.

This article discusses in more detail how to recognize palmoplantar psoriasis, what causes it, how to treat it, and when to contact a doctor.

Palmoplantar psoriasis can occur as part of the more general plaque psoriasis, or it may only affect the palms of the hands and the soles of the feet.

A 2015 study found that the condition affected both the hands and feet in just over half of 237 participants.

Symptoms include:

• well-defined areas of raised, thickened skin
• scaling
• an itching and burning sensation
• pain
• cracking and bleeding

There may also be:

• small pustules
• skin changes on up to one-tenth of the rest of the body, due to general plaque psoriasis
• pitting, ridging, and thickening of the nails, also due to general plaque psoriasis

The patterns may be symmetrical, for example, similar on both hands.

Palmoplantar psoriasis can make it difficult to carry out everyday activities, such as walking. The location of symptoms also makes it harder to keep the lesions clean and to cover them, potentially leading to embarrassment and social anxiety.

Moreover, a 2016 study suggests that palmoplantar pustulosis is genetically similar to palmoplantar psoriasis. A person with the pustular form will have clusters of white pustules alongside the plaques.

Palmoplantar psoriasis on skin of color

Generally, plaque psoriasis on skin of color may not appear as pink. The plaques may be thicker and more silver-looking.

Some plaques may look more purple. A person is also likely to develop darkening or lightening of parts of the skin, which health experts call hyperpigmentation and hypopigmentation, respectively.

Palmoplantar psoriasis may be more common in white populations. However, among People of Color, the condition tends to impact people of India the most.

Is palmoplantar psoriasis a disability?

Psoriasis in general can be very disabling. With proper medical documentation, a person with psoriasis may qualify for social security disability payments.

According to research, palmoplantar psoriasis can be even more disabling, because it affects the hands or feet.

However, although each case is different, palmoplantar psoriasis may not necessarily have a more severe impact on a person’s mental health or life overall than psoriasis generally does.

The following images show how palmoplantar psoriasis may appear on the skin.

Share on PinterestPalmoplantar psoriasis is a subtype of psoriasis and primarily affects the hands and feet. Bangmaha Art/EyeEm/Getty ImagesShare on PinterestPalmoplantar psoriasis is a chronic inflammatory skin disease.
Santosh kumar parida/ShutterstockShare on PinterestOver time, the skin becomes thickened and painful with dry cracks in the skin.
Photography courtesy of MCvanVeen/WikimediaShare on PinterestIn severe cases, blisters and pustules can form on the hands and feet.
Photography courtesy of Masryyy/WikimediaShare on PinterestSteroids and topical medications are typical treatments.
‘Murugaiyan R, Sengottian KL, Karthikeyan K. Crusted scabies presenting as palmoplantar psoriasis in Down’s syndrome. Indian Dermatol Online J. 2015 Mar-Apr;6(2):140-1. doi: 10.4103/2229-5178.153025. PMID: 25821745; PMCID: PMC4375766.Share on PinterestIt is a reoccurring inflammatory condition and has many different triggers.
Photography by DermNet New Zealand

Palmoplantar psoriasis, like other forms of psoriasis, is an autoimmune condition. A problem with the immune system causes skin cells to develop too quickly.

In palmoplantar psoriasis, the plaques affect the skin of the palms of the hands and the soles of the feet.

Experts do not know exactly what causes palmoplantar psoriasis. However, it may be due to a combination of genetic and environmental factors. A problem with certain sweat glands could play a role as well.

Is palmoplantar psoriasis contagious?

Psoriasis is an autoimmune condition, and therefore, it is not contagious. This means people cannot contract it by coming into contact with the affected skin of a person with the condition the way they could contract a virus or bacteria.

However, if someone is experiencing symptoms and does not yet have a diagnosis of psoriasis, they should seek medical attention. This is because, although rare, some contagious conditions, such as secondary syphilis, may mimic the symptoms of palmoplantar psoriasis.

Environmental risk factors and lifestyle choices may increase the likelihood of palmoplantar psoriasis.

The hands and feet are more open to exposure to environmental and chemical triggers. This may play a role in the development and progression of the condition.

The following appear to increase the risk:

• household work
• farm work
• manual labor
• exposure to chemical and physical irritants, such as detergents
• exposure to allergens
• smoking

Also, individuals with the following conditions may have a higher risk of developing palmoplantar psoriasis:

• thyroid disease
• arthritis of the anterior thorax
• type 1 diabetes
• gluten intolerance
• streptococcal tonsillitis

Around 10–25% of people with palmoplantar psoriasis have chronic plaque psoriasis.

Furthermore, research indicates that smoking may be a big factor in the development of palmoplantar psoriasis. Most people with the condition either currently smoke or have previously smoked.

The condition may also flare up during periods of anxiety or stress.

Palmoplantar psoriasis is a type of psoriasis, and people with psoriasis in general may develop other serious medical conditions.

According to the National Psoriasis Foundation (NPF), individuals with psoriasis often have a higher risk of developing:

• Crohn’s disease
• hardening of the arteries
• type 2 diabetes
• depression
• cancer
• liver disease
• kidney disease
• metabolic syndrome
• eye infections, such as uveitis
• osteoporosis
• obesity

People with palmoplantar psoriasis and other types of psoriasis also have an increased risk of psoriatic arthritis, which affects the joints.

Doctors can prescribe medication to reduce discomfort during a psoriasis flare.

To diagnose the condition, a doctor will look at the symptoms and ask the person about their medical history.

Also, they may carry out a biopsy and take a small skin sample to rule out other inflammatory skin conditions, such as eczema, contact dermatitis, or a fungal infection.

Often, doctors can diagnose psoriasis based on skin appearance alone.

There is little information about treatment specifically for palmoplantar psoriasis.

However, options that may relieve symptoms usually involve the following, alone or in combination:

• topical corticosteroids
• synthetic vitamin D
• light therapy
• systemic medications
• biologic medications, for cases that do not respond to other treatments
• oral retinoids

A person may have to work with a doctor and try several treatments to find the most suitable one.

How do the treatments work?

Corticosteroids will be the first line of treatment, but a doctor may alternate these with synthetic vitamin D medication, such as calcipotriene (Dovonex) and calcitriol (Rocaltrol).

Light therapy

The second-line treatment is light therapy. Exposure to natural forms of UVB and UVA light may help slow down the speed at which skin cells grow.

The doctor may recommend starting with 5–10 minutes of daily exposure to sunlight and then increasing exposure time by 30 seconds every day if the response is good.

The person should apply sunscreen to areas of the skin that do not have psoriasis.

A treatment known as PUVA may help. This combines natural light exposure and a drug called psoralen oral photosensitizing medication.

Other light therapies include NB-UVA and a monochromatic excimer laser.

Systemic treatments

Systemic treatments affect the whole body.

Psoriasis occurs when the immune system does not work properly, and skin cells grow too quickly. A systemic mediation can help prevent this.

A 2021 review notes that doctors prescribe methotrexate and cyclosporine for psoriasis.

Biologics

Biologics are targeted therapies that can change the body’s immune response. They may help manage the symptoms of psoriasis when other treatments have proven ineffective.

However, some of these can have severe side effects. A doctor will need to monitor the person’s progress.

Examples of biologic drugs for psoriasis include:

• interleukin (IL)-12/23 antagonist ustekinumab (Stelara)
• IL-17 antagonists, such as secukinumab (Cosentyx)
• phosphodiesterase 4 inhibitors, such as apremilast (Otezla)

People have used anti-tumor necrosis factor alpha antagonists, such as infliximab, etanercept, and adalimumab. However, these have worsened symptoms in some individuals.

Oral retinoids

A dermatologist may also prescribe oral retinoids. These medications help reduce skin cells that are growing too fast, along with associated swelling and redness.

Doctors commonly prescribe acitretin (Soriatane), which is an oral medication a person takes once daily. It suppresses the immune system, which may make it a good choice for individuals with a weakened immune system.

Some home remedies may help reduce pain and discomfort.

Bathing and soaking

Bathing can alleviate palmoplantar psoriasis symptoms, but it is important to choose the right temperature and products.

1. Soak the hands and feet in lukewarm water.
2. Add a soothing natural substance, such as oatmeal or Dead Sea salt.
3. Use mild soaps and bath oils that are free from added colors and fragrance.
4. Blot the skin dry after soaking with a soft, clean cloth to avoid irritation.
5. Apply moisturizer to the damp skin.

Humidity and moisture

Tips for reducing dryness include using a humidifier, as well as moisturizing the skin several times per day, especially in dry weather.

Moisturizers with naturally soothing, anti-inflammatory properties, such as aloe vera, may relieve symptoms. A range of moisturizers for psoriasis are available for purchase online.

A doctor or pharmacist can advise about a suitable lotion, oil, or cream for moisturizing.

Supplements and alternative treatments

The NPF suggests some herbs and natural remedies that may help with psoriasis in general:

• Tea tree oil: Always dilute with a carrier, such as almond oil, before applying. Do not take by mouth. Some people may have an allergic reaction.
• Capsaicin: Some people find that applying a cream containing capsaicin, the spicy ingredient in chili peppers, to the skin may help reduce itching and burning.
• Epsom or Dead Sea salt: Add it to lukewarm water to soak the hands or feet.
• Oatmeal: You can add it to a soak or a bath.
• Mahonia aquifolium: Applying a 10% topical cream may help reduce mild to moderate symptoms of psoriasis.
• Apple cider vinegar: Apply directly to the skin or dilute in equal parts with water. You can also add it to salads to take it by mouth.
• Turmeric: Adding this spice to food or taking turmeric supplements may help with some types of psoriasis.
• Raw honey: According to a 2019 case study, using raw honey may be an effective way to reduce symptoms.

It is advisable to consult a healthcare professional before using any of these, to make sure they are safe and suitable for a person to use.

A person can apply a small amount to a small area of the skin to check their reaction, in case they have an allergy or the treatment makes their symptoms worse.

Is palmoplantar psoriasis curable?

Palmoplantar psoriasis tends to be a long-term condition. Currently, there is no cure, but treatment can help manage symptoms.

Genetic factors are likely to play a role in the development of psoriasis, and therefore, it can be difficult to prevent the condition.

However, psoriasis may also occur in response to some environmental triggers, such as having exposure to chemicals or detergents, smoking, consuming alcohol, and experiencing stress.

If a person can identify any of their triggers, they can try to avoid it and thus help reduce flare-ups.

Read this article in Spanish.

Palmoplantar Psoriasis: Causes, Symptoms, Risks, Treatment

Palmoplantar psoriasis is a form of psoriasis that affects the palms of the hands and the soles of the feet. It causes areas of raised, thickened, and discolored skin and can lead to pain, bleeding, and skin cracking.

Palmoplantar psoriasis is psoriasis on the hands, although it can appear almost anywhere on the body, including the feet. The condition is a subtype of both plaque psoriasis and pustular psoriasis, depending on how it manifests.

According to research, psoriasis affects 2–5% of the population, and 3–4% of individuals with psoriasis have palmoplantar psoriasis. Palmoplantar psoriasis can occur at any age. A related condition, palmoplantar pustulosis, usually starts between the ages of 20 and 60 years.

A person may not have symptoms all the time. Often, they will experience times of remission and then a flare. Certain triggers can cause a flare.

This article discusses in more detail how to recognize palmoplantar psoriasis, what causes it, how to treat it, and when to contact a doctor.

Palmoplantar psoriasis can occur as part of the more general plaque psoriasis, or it may only affect the palms of the hands and the soles of the feet.

A 2015 study found that the condition affected both the hands and feet in just over half of 237 participants.

Symptoms include:

• well-defined areas of raised, thickened skin
• scaling
• an itching and burning sensation
• pain
• cracking and bleeding

There may also be:

• small pustules
• skin changes on up to one-tenth of the rest of the body, due to general plaque psoriasis
• pitting, ridging, and thickening of the nails, also due to general plaque psoriasis

The patterns may be symmetrical, for example, similar on both hands.

Palmoplantar psoriasis can make it difficult to carry out everyday activities, such as walking. The location of symptoms also makes it harder to keep the lesions clean and to cover them, potentially leading to embarrassment and social anxiety.

Moreover, a 2016 study suggests that palmoplantar pustulosis is genetically similar to palmoplantar psoriasis. A person with the pustular form will have clusters of white pustules alongside the plaques.

Palmoplantar psoriasis on skin of color

Generally, plaque psoriasis on skin of color may not appear as pink. The plaques may be thicker and more silver-looking.

Some plaques may look more purple. A person is also likely to develop darkening or lightening of parts of the skin, which health experts call hyperpigmentation and hypopigmentation, respectively.

Palmoplantar psoriasis may be more common in white populations. However, among People of Color, the condition tends to impact people of India the most.

Is palmoplantar psoriasis a disability?

Psoriasis in general can be very disabling. With proper medical documentation, a person with psoriasis may qualify for social security disability payments.

According to research, palmoplantar psoriasis can be even more disabling, because it affects the hands or feet.

However, although each case is different, palmoplantar psoriasis may not necessarily have a more severe impact on a person’s mental health or life overall than psoriasis generally does.

The following images show how palmoplantar psoriasis may appear on the skin.

Share on PinterestPalmoplantar psoriasis is a subtype of psoriasis and primarily affects the hands and feet. Bangmaha Art/EyeEm/Getty ImagesShare on PinterestPalmoplantar psoriasis is a chronic inflammatory skin disease.
Santosh kumar parida/ShutterstockShare on PinterestOver time, the skin becomes thickened and painful with dry cracks in the skin.
Photography courtesy of MCvanVeen/WikimediaShare on PinterestIn severe cases, blisters and pustules can form on the hands and feet.
Photography courtesy of Masryyy/WikimediaShare on PinterestSteroids and topical medications are typical treatments.
‘Murugaiyan R, Sengottian KL, Karthikeyan K. Crusted scabies presenting as palmoplantar psoriasis in Down’s syndrome. Indian Dermatol Online J. 2015 Mar-Apr;6(2):140-1. doi: 10.4103/2229-5178.153025. PMID: 25821745; PMCID: PMC4375766.Share on PinterestIt is a reoccurring inflammatory condition and has many different triggers.
Photography by DermNet New Zealand

Palmoplantar psoriasis, like other forms of psoriasis, is an autoimmune condition. A problem with the immune system causes skin cells to develop too quickly.

In palmoplantar psoriasis, the plaques affect the skin of the palms of the hands and the soles of the feet.

Experts do not know exactly what causes palmoplantar psoriasis. However, it may be due to a combination of genetic and environmental factors. A problem with certain sweat glands could play a role as well.

Is palmoplantar psoriasis contagious?

Psoriasis is an autoimmune condition, and therefore, it is not contagious. This means people cannot contract it by coming into contact with the affected skin of a person with the condition the way they could contract a virus or bacteria.

However, if someone is experiencing symptoms and does not yet have a diagnosis of psoriasis, they should seek medical attention. This is because, although rare, some contagious conditions, such as secondary syphilis, may mimic the symptoms of palmoplantar psoriasis.

Environmental risk factors and lifestyle choices may increase the likelihood of palmoplantar psoriasis.

The hands and feet are more open to exposure to environmental and chemical triggers. This may play a role in the development and progression of the condition.

The following appear to increase the risk:

• household work
• farm work
• manual labor
• exposure to chemical and physical irritants, such as detergents
• exposure to allergens
• smoking

Also, individuals with the following conditions may have a higher risk of developing palmoplantar psoriasis:

• thyroid disease
• arthritis of the anterior thorax
• type 1 diabetes
• gluten intolerance
• streptococcal tonsillitis

Around 10–25% of people with palmoplantar psoriasis have chronic plaque psoriasis.

Furthermore, research indicates that smoking may be a big factor in the development of palmoplantar psoriasis. Most people with the condition either currently smoke or have previously smoked.

The condition may also flare up during periods of anxiety or stress.

Palmoplantar psoriasis is a type of psoriasis, and people with psoriasis in general may develop other serious medical conditions.

According to the National Psoriasis Foundation (NPF), individuals with psoriasis often have a higher risk of developing:

• Crohn’s disease
• hardening of the arteries
• type 2 diabetes
• depression
• cancer
• liver disease
• kidney disease
• metabolic syndrome
• eye infections, such as uveitis
• osteoporosis
• obesity

People with palmoplantar psoriasis and other types of psoriasis also have an increased risk of psoriatic arthritis, which affects the joints.

Doctors can prescribe medication to reduce discomfort during a psoriasis flare.

To diagnose the condition, a doctor will look at the symptoms and ask the person about their medical history.

Also, they may carry out a biopsy and take a small skin sample to rule out other inflammatory skin conditions, such as eczema, contact dermatitis, or a fungal infection.

Often, doctors can diagnose psoriasis based on skin appearance alone.

There is little information about treatment specifically for palmoplantar psoriasis.

However, options that may relieve symptoms usually involve the following, alone or in combination:

• topical corticosteroids
• synthetic vitamin D
• light therapy
• systemic medications
• biologic medications, for cases that do not respond to other treatments
• oral retinoids

A person may have to work with a doctor and try several treatments to find the most suitable one.

How do the treatments work?

Corticosteroids will be the first line of treatment, but a doctor may alternate these with synthetic vitamin D medication, such as calcipotriene (Dovonex) and calcitriol (Rocaltrol).

Light therapy

The second-line treatment is light therapy. Exposure to natural forms of UVB and UVA light may help slow down the speed at which skin cells grow.

The doctor may recommend starting with 5–10 minutes of daily exposure to sunlight and then increasing exposure time by 30 seconds every day if the response is good.

The person should apply sunscreen to areas of the skin that do not have psoriasis.

A treatment known as PUVA may help. This combines natural light exposure and a drug called psoralen oral photosensitizing medication.

Other light therapies include NB-UVA and a monochromatic excimer laser.

Systemic treatments

Systemic treatments affect the whole body.

Psoriasis occurs when the immune system does not work properly, and skin cells grow too quickly. A systemic mediation can help prevent this.

A 2021 review notes that doctors prescribe methotrexate and cyclosporine for psoriasis.

Biologics

Biologics are targeted therapies that can change the body’s immune response. They may help manage the symptoms of psoriasis when other treatments have proven ineffective.

However, some of these can have severe side effects. A doctor will need to monitor the person’s progress.

Examples of biologic drugs for psoriasis include:

• interleukin (IL)-12/23 antagonist ustekinumab (Stelara)
• IL-17 antagonists, such as secukinumab (Cosentyx)
• phosphodiesterase 4 inhibitors, such as apremilast (Otezla)

People have used anti-tumor necrosis factor alpha antagonists, such as infliximab, etanercept, and adalimumab. However, these have worsened symptoms in some individuals.

Oral retinoids

A dermatologist may also prescribe oral retinoids. These medications help reduce skin cells that are growing too fast, along with associated swelling and redness.

Doctors commonly prescribe acitretin (Soriatane), which is an oral medication a person takes once daily. It suppresses the immune system, which may make it a good choice for individuals with a weakened immune system.

Some home remedies may help reduce pain and discomfort.

Bathing and soaking

Bathing can alleviate palmoplantar psoriasis symptoms, but it is important to choose the right temperature and products.

1. Soak the hands and feet in lukewarm water.
2. Add a soothing natural substance, such as oatmeal or Dead Sea salt.
3. Use mild soaps and bath oils that are free from added colors and fragrance.
4. Blot the skin dry after soaking with a soft, clean cloth to avoid irritation.
5. Apply moisturizer to the damp skin.

Humidity and moisture

Tips for reducing dryness include using a humidifier, as well as moisturizing the skin several times per day, especially in dry weather.

Moisturizers with naturally soothing, anti-inflammatory properties, such as aloe vera, may relieve symptoms. A range of moisturizers for psoriasis are available for purchase online.

A doctor or pharmacist can advise about a suitable lotion, oil, or cream for moisturizing.

Supplements and alternative treatments

The NPF suggests some herbs and natural remedies that may help with psoriasis in general:

• Tea tree oil: Always dilute with a carrier, such as almond oil, before applying. Do not take by mouth. Some people may have an allergic reaction.
• Capsaicin: Some people find that applying a cream containing capsaicin, the spicy ingredient in chili peppers, to the skin may help reduce itching and burning.
• Epsom or Dead Sea salt: Add it to lukewarm water to soak the hands or feet.
• Oatmeal: You can add it to a soak or a bath.
• Mahonia aquifolium: Applying a 10% topical cream may help reduce mild to moderate symptoms of psoriasis.
• Apple cider vinegar: Apply directly to the skin or dilute in equal parts with water. You can also add it to salads to take it by mouth.
• Turmeric: Adding this spice to food or taking turmeric supplements may help with some types of psoriasis.
• Raw honey: According to a 2019 case study, using raw honey may be an effective way to reduce symptoms.

It is advisable to consult a healthcare professional before using any of these, to make sure they are safe and suitable for a person to use.

A person can apply a small amount to a small area of the skin to check their reaction, in case they have an allergy or the treatment makes their symptoms worse.

Is palmoplantar psoriasis curable?

Palmoplantar psoriasis tends to be a long-term condition. Currently, there is no cure, but treatment can help manage symptoms.

Genetic factors are likely to play a role in the development of psoriasis, and therefore, it can be difficult to prevent the condition.

However, psoriasis may also occur in response to some environmental triggers, such as having exposure to chemicals or detergents, smoking, consuming alcohol, and experiencing stress.

If a person can identify any of their triggers, they can try to avoid it and thus help reduce flare-ups.

Read this article in Spanish.

Psoriasis of the palms and soles. What is Psoriasis of the Hands and Soles?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Psoriasis of the palms and soles is a palmoplantar variety of pustular psoriasis affecting exclusively the skin of the palms and soles. The primary element is a bright pink papule, which transforms into a plaque that occurs against the background of hyperemia of the skin surface, accompanied by itching and flaking. The plaques merge with each other, forming foci of hyperkeratosis, sometimes some of the foci begin to resolve from the center. The surface of the palms and feet loses elasticity, cracks appear, and a secondary infection joins. The diagnosis is made clinically with histological confirmation. In the course of treatment, external antiseptics, hormonal ointments and PUVA therapy are used.

• Causes of psoriasis of the palms and soles
• Classification of psoriasis of the palms and soles
• Symptoms of psoriasis of the palms and soles
• Diagnosis of psoriasis of the palms and soles
• Treatment and prevention of psoriasis of the palms and soles
• Prices for treatment

General information

Psoriasis of the palms and soles is a chronic heterogeneous dermatosis localized in the area of ​​the palms and soles. According to different authors, the palmoplantar form of the disease accounts for 1.2% to 31% of all cases of psoriasis, while recently the number of patients has been steadily growing, which increases the relevance of this dermatological pathology. Dermatosis is dependent on geography and race. In northern countries, the incidence of psoriasis of the palms and soles is much higher than in southern countries: in the Far North of Russia, dermatosis is assigned 4%, and in Kuwait – only 0. 11%. Along with other factors, the occurrence of dermatosis is negatively affected by bad habits, especially smoking and an atherogenic dietary profile.

Dermatologists associate genetic predisposition in the development of the disease with subpopulation characteristics. For example, American Indians and representatives of the Negroid race practically do not suffer from this pathology, while in Europeans the disease is detected quite often. There are no gender or seasonal differences. The age peak incidence falls on the age of over 30 years and accounts for up to 15% of cases of disability from skin diseases in general. Dermatosis is not contagious, in the entire history of dermatological observations, despite the localization of the pathological process on the palms (handshakes), not a single case of transmission of palmoplantar psoriasis from a sick person to a healthy one has been recorded. The disease does not spread even through blood transfusion.

Psoriasis of the palms and soles

Causes of psoriasis of the palms and soles

Dermatosis is heterogeneous. There are exogenous and endogenous triggers of the disease. Exogenous factors include temperature fluctuations in the environment, bad habits, prolonged use of drugs, infections, injuries, and an atherogenic dietary profile. Endogenous factors include hereditary predisposition, weakened immunity, stress and sensitization of the body. Provoking factors trigger the mechanism for the development of the pathological process. Modern dermatologists tend to consider psoriasis of the palms and soles as the result of a combination of several triggers.

The mechanism of the disease is not fully understood, there are several most likely theories, the main one is autoimmune. A defective gene, inherited and responsible for the functional activity of immunity, becomes a trigger that stimulates the production of antibodies. Antibodies take the cells of the surface layer of the epidermis for a foreign principle. Binding and destroying the cells of the stratum corneum of the skin, the resulting autoimmune reaction leads, on the one hand, to degenerative processes in the dermis, on the other hand, to a compensatory rapid division of healthy epidermal cells and inflammation in the skin, which is visually manifested first by erythema, and then by the formation of papules and peeling .

The exchange theory is based on dietary errors. An atherogenic (“fatty”) nutritional profile is a provoking factor in lipid and protein metabolism disorders. The absence of the necessary building material (proteins) in sufficient quantities and the predominance of energetically active fats leads to the synthesis of toxic polyamines in the digestive tract. Toxic compounds cause degenerative-dystrophic changes in the skin and trigger an autoimmune process.

Neuroendocrine theory suggests a different mechanism for the development of the disease. Stress and endocrine disorders lead to a change in the normal innervation and trophism of the skin, which disrupts the integrity of dermal cells, stimulates T-helper activity, changes the cytokine profile with the development of inflammation, increased keratinization processes and proliferation of epidermal cells. As a result, primary elements appear on the palms and soles. At the same time, the localization of the pathological process is due exclusively to local provoking factors (skin injuries, exposure to ultraviolet radiation, or pre-existing contact dermatitis).

The allergic theory boils down to the fact that when exposed to any foreign antigen, the skin, already sensitized by taking drugs, sunlight, infection and temperature fluctuations, gives a super-strong response with the production of a large number of antibodies that destroy dermal cells, and the development of an autoimmune reaction. Separately, one more autoimmune reaction should be mentioned, which is the result of a viral HIV infection, which leads to a change in the number of lymphocytes, which, in combination with apoptosis (regulated programmed cell death), is visually manifested by the same rashes on the skin.

Classification of psoriasis of the palms and soles

In modern practical dermatology, three forms of the pathological process are distinguished depending on the predominance of certain primary elements:

Vulgar (typical, papular-plaque) form, characterized by a rash of dense pink papules and plaques up to 2. 5 mm in diameter with clear boundaries, covered with silvery scales. The primary elements are tightly soldered to the underlying tissues, combined with skin cracks and secondary infection, which often makes it impossible to identify the diagnostic triad.

Symptoms of psoriasis of the palms and soles

Despite some differences in the different forms of palmoplantar psoriasis, common signs of dermatosis can be identified. Very small (1-1.5 mm) primary papular elements appear on slightly edematous and hyperemic skin in the area of ​​the palms and soles, transforming into plaques, which, merging, form dense foci with clear outlines. Elements practically do not rise above the level of healthy skin. Due to hyperkeratosis, cracks form on their surface, pain occurs that disrupts the ability to work and negatively affects the quality of life of the patient. Over time, the inflammation subsides, hyperkeratosis intensifies, the foci turn yellow and thicken, almost completely covering the palm or sole.

Berber’s psoriasis has a slightly different course. The primary element of this form of dermatosis is a pustule, prone to coalescence and the formation of large purulent foci with sterile contents. Pustules dry up and form crusts with typical psoriatic large-lamellar peeling. Rashes are localized on the arch of the foot and in the area of ​​the thumb on the hands. A feature of psoriasis of the palms and soles is the possible presence of single plaques in other areas of the skin.

Diagnosis of psoriasis of the palms and soles

Clinical diagnosis is carried out by a dermatologist. If possible, the diagnosis is confirmed by a specific triad revealed by scraping of the papules (stearin stain, terminal film, dew drops). Be sure to conduct a histological examination. In the affected areas of the skin, a sharp acanthosis with papillomatosis, hyperkeratosis, cell proliferation and thinning of the upper layers of the epidermis is found. In difficult cases, immunomorphological studies are used, which indicate the autoimmune nature of psoriasis of the palms and soles.

Pathology is differentiated from lichen planus, horny and dyshidrotic eczema, neurodermatitis, pink lichen, papular syphilis, keratoderma, Allopo’s acrodermatitis, Andrews’ bacteride, gonorrheal and arsenic hyperkeratosis and palmoplantar-oral syndrome caused by the Coxsackie virus.

Treatment and prevention of psoriasis of the palms and soles

Treatment of the disease is carried out under the supervision of a dermatologist. In systemic therapy, drugs are used orally or by injection. The list of drugs used includes glucocorticoids, aromatic retinoids, cytostatics, immunosuppressants and special photoactive compounds. The best results are obtained by combining PUVA therapy for psoriasis with the subsequent addition of an excimer laser. Outwardly, hormonal ointments are used in their pure form or in combination with salicylic acid. Assign analogues of vitamin D3, fat-soluble vitamins in courses of 30 days, baths with bran, string and celandine.

For prevention, an anti-atherogenic diet should be observed, chocolate, coffee and alcohol should be excluded from the diet (products that can provoke a relapse). It is necessary to make a choice in favor of a healthy lifestyle, monitor the absence of contact of the skin of the hands with provoking factors, use gloves in the household, wear tight socks in the cold season and use open shoes in the summer. When prescribing medications, a consultation with a dermatologist is mandatory. The prognosis is relatively favorable.

You can share your medical history, what helped you in the treatment of psoriasis of the palms and soles.

Sources

1. self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

   Palmar and plantar psoriasis – Treatment of psoriasis and vitiligo in Almaty.

   Approximately one quarter of patients with psoriasis have lesions on the palms and soles of the feet. In this case, they speak of palmar-plantar psoriasis. The following varieties are distinguished:

   Pustular psoriasis of the palms and soles (Barber’s psoriasis) . Infections, stress, certain medications, and hormonal problems contribute to its occurrence. The rash is formed by pustules – superficial pustular elements, which are located both against the background of clearly defined plaques, and on other parts of the skin. Often there is a pronounced infiltration of the skin. Most often, rashes are located in the area of ​​\u200b\u200bthe elevation of the thumb and little finger on the hands and on the arch of the foot on the legs. The general condition of patients does not suffer. This form of psoriasis is persistent, recurs frequently, and is difficult to treat.

   Psoriasis vulgaris with isolated lesions of the palms and soles of the feet – represented by infiltrated plaques that have a clearly defined shape, the foci can be in the form of keratosis (skin thickening), which looks like a callus with irregular outlines, with a layering of tightly fitting large silvery- white or yellowish scales, if scraped off, the juicy pinkish-red base of the plaques is exposed. Some plaques may have fissures that are quite painful and prone to bleeding.

   In plantar psoriasis, the skin is red (hyperemic), edematous and indurated. Less pronounced manifestations are observed on the palms. Almost all the time, skin lesions are observed on both hands. The skin of the palms and soles becomes very dry and prone to inflammation and cracking.

   Quite common is the nail lesion, which can be of two types:

   In the first case, there are numerous pinpoint depressions on the nail plate, while the picture resembles the surface of a thimble (thimble symptom).
   In the second case, there are yellow-brown spots under the nail (“oil spot” symptom), there may also be marginal onycholysis – partial separation of the nail plate from the nail bed, sometimes the plate can split.

   It should be noted that simultaneously with lesions of the hands and feet, there are lesions localized in other places. Palmar-plantar psoriasis causes a lot of suffering to patients, because the pathology of the skin of this localization is difficult to hide from others. In addition, the affected skin can make it difficult to perform normal daily activities, such as dressing. fabric clings to rough skin.

   How to treat palmar-plantar psoriasis

   Treatment of palmar-plantar psoriasis is a rather complicated process, which is characterized by refractoriness (immunity) to ongoing therapy methods. This is due to more pronounced pathological changes in the epidermis and dermis, constant trauma and irritation of the skin of the hands and feet (washing, shoes, clothes). As with other forms of this disease, with psoriasis of the palms and soles, patients must adhere to certain recommendations for nutrition and skin care. It is recommended to give up spicy and fried foods, alcohol and smoking. Do not wash your hands with hot water, to prevent the irritating effect of household chemicals, you can use fabric-based rubber gloves. If there are cracks on the foot, a hydrocolloid solution can be prescribed, which is applied to the affected areas and protects them from shoe friction, relieves itching and promotes rapid healing.

   At the heart of the pathogenetic (aimed at changes underlying the disease) effect of therapy in psoriasis is the suppression of the reproduction of keratinocytes, the normalization of their development and maturation, and the reduction of the inflammatory response.