What is palmoplantar psoriasis. How does it affect the hands and feet. What are the main symptoms and treatment options. Is palmoplantar psoriasis contagious or disabling. How does it differ on skin of color.

Understanding Palmoplantar Psoriasis: A Chronic Skin Condition

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 causes thickened, discolored patches of skin that can be painful and interfere with daily activities. While it shares similarities with other types of psoriasis, its location and impact on quality of life make it a unique challenge for those affected.

Affecting approximately 3-4% of individuals with psoriasis, palmoplantar psoriasis can occur at any age. It is considered a subtype of both plaque psoriasis and pustular psoriasis, depending on its presentation. The condition is characterized by periods of remission and flare-ups, with certain triggers potentially exacerbating symptoms.

Recognizing the Symptoms of Palmoplantar Psoriasis

Identifying palmoplantar psoriasis is crucial for proper management and treatment. The condition manifests with distinct symptoms that can vary in severity:

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

Are the symptoms always present? No, individuals with palmoplantar psoriasis often experience periods of remission followed by flare-ups. The pattern of symptoms may be symmetrical, affecting both hands or feet similarly.

Impact on Daily Life

The location of palmoplantar psoriasis can significantly impact a person’s ability to perform everyday tasks. Walking may become painful, and using hands for various activities can be challenging. Additionally, the visible nature of the condition on hands and feet can lead to social anxiety and embarrassment, potentially affecting a person’s mental health and overall well-being.

Causes and Risk Factors of Palmoplantar Psoriasis

Like other forms of psoriasis, palmoplantar psoriasis is an autoimmune condition. The exact cause remains unknown, but researchers believe it results from a combination of genetic predisposition and environmental triggers. An overactive immune system leads to accelerated skin cell growth, resulting in the characteristic plaques on the palms and soles.

Can palmoplantar psoriasis be inherited? While there is a genetic component, having a family history of psoriasis doesn’t guarantee developing the condition. Environmental factors and lifestyle choices can also play a role in triggering or exacerbating symptoms.

Potential Triggers

• Stress
• Skin injuries or trauma
• Certain medications
• Infections
• Cold, dry weather
• Smoking
• Alcohol consumption

Identifying and managing these triggers can be an essential part of controlling palmoplantar psoriasis symptoms.

Diagnosing Palmoplantar Psoriasis: What to Expect

Diagnosing palmoplantar psoriasis typically involves a thorough examination by a dermatologist. The process may include:

1. Visual inspection of the affected areas
2. Review of medical history and symptoms
3. Skin biopsy in some cases to rule out other conditions
4. Assessment of nail changes and other body areas for signs of psoriasis

How is palmoplantar psoriasis distinguished from other skin conditions? The characteristic appearance of thick, scaly plaques on the palms and soles, combined with a history of psoriasis or family history, often points to palmoplantar psoriasis. However, conditions like eczema or fungal infections may present similarly, necessitating careful evaluation.

Treatment Options for Palmoplantar Psoriasis

Managing palmoplantar psoriasis often requires a multifaceted approach, combining topical treatments, systemic medications, and lifestyle modifications. The severity of symptoms and individual patient factors guide treatment choices.

Topical Treatments

• Corticosteroid creams or ointments
• Vitamin D analogs
• Retinoids
• Salicylic acid
• Moisturizers and emollients

Are topical treatments alone sufficient for severe cases? While mild to moderate cases may respond well to topical therapies, more severe or persistent palmoplantar psoriasis often requires additional treatment modalities.

Systemic Medications

• Oral retinoids
• Methotrexate
• Cyclosporine
• Biologics (e.g., TNF inhibitors, IL-17 inhibitors)

Phototherapy

Controlled exposure to ultraviolet light, either UVB or PUVA (psoralen plus UVA), can help reduce inflammation and slow skin cell growth in some cases.

Lifestyle Modifications

• Stress management techniques
• Regular moisturizing
• Avoiding known triggers
• Gentle skin care practices
• Dietary changes (in consultation with a healthcare provider)

Can lifestyle changes alone control palmoplantar psoriasis? While lifestyle modifications are an important part of managing the condition, most individuals require a combination of medical treatments and lifestyle changes for optimal symptom control.

Living with Palmoplantar Psoriasis: Coping Strategies and Support

Dealing with palmoplantar psoriasis can be challenging, both physically and emotionally. Implementing coping strategies and seeking support can significantly improve quality of life:

• Join support groups or online communities
• Educate friends and family about the condition
• Explore stress-reduction techniques like meditation or yoga
• Work with a therapist to address any psychological impacts
• Communicate openly with healthcare providers about concerns and treatment efficacy

How can patients manage the emotional impact of palmoplantar psoriasis? Seeking professional help from a mental health provider experienced in chronic health conditions can be beneficial. Cognitive-behavioral therapy and mindfulness practices have shown promise in helping individuals cope with the psychological aspects of psoriasis.

Palmoplantar Psoriasis in People of Color: Unique Considerations

While palmoplantar psoriasis can affect individuals of all skin tones, its presentation and impact may vary in people with darker skin:

• Plaques may appear more purple or darker than the surrounding skin
• Scaling may be less noticeable but thicker
• Post-inflammatory hyper- or hypopigmentation is more common
• Diagnosis may be challenging due to differences in appearance

Is palmoplantar psoriasis more common in certain ethnic groups? Research suggests that while the condition may be more prevalent in white populations, among people of color, those of Indian descent seem to be more frequently affected. However, it’s crucial to note that psoriasis can occur in individuals of any ethnic background.

Cultural Considerations in Treatment

Healthcare providers should be aware of cultural factors that may influence treatment preferences and adherence. Some considerations include:

• Skin lightening concerns with certain treatments
• Cultural practices involving hands and feet
• Potential stigma associated with visible skin conditions
• Access to healthcare and specialized dermatology services

Palmoplantar Psoriasis and Disability: Understanding the Impact

The location and severity of palmoplantar psoriasis can significantly impact an individual’s ability to perform daily activities and work-related tasks. In some cases, the condition may be considered disabling:

• Difficulty walking or standing for extended periods
• Challenges with manual tasks requiring dexterity
• Pain and discomfort affecting job performance
• Potential for secondary infections due to cracked skin

Can individuals with palmoplantar psoriasis qualify for disability benefits? In severe cases, with proper medical documentation, individuals may be eligible for social security disability payments. The impact on daily functioning and ability to work are key factors in determining eligibility.

Workplace Accommodations

For those able to work, certain accommodations may help manage symptoms and improve job performance:

• Ergonomic tools and equipment
• Flexible work schedules to accommodate treatment regimens
• Protective gear for hands and feet
• Breaks for applying moisturizers or medications

Research and Future Directions in Palmoplantar Psoriasis Treatment

Ongoing research into palmoplantar psoriasis aims to improve understanding of the condition and develop more targeted treatments:

• Genetic studies to identify specific risk factors
• Investigation of the role of certain sweat glands in disease development
• Clinical trials for new biologic therapies
• Exploration of combination treatments for enhanced efficacy

What promising treatments are on the horizon for palmoplantar psoriasis? Several new biologics targeting specific inflammatory pathways are in development. Additionally, researchers are exploring the potential of JAK inhibitors and other small molecule drugs for managing resistant cases.

Personalized Medicine Approaches

The future of palmoplantar psoriasis treatment may lie in personalized medicine approaches:

• Genetic testing to predict treatment response
• Biomarker identification for tailored therapy selection
• Individualized treatment plans based on patient-specific factors

These advancements hold promise for improving outcomes and quality of life for individuals living with palmoplantar psoriasis.

Preventing Flare-ups and Maintaining Skin Health

While it’s not always possible to prevent palmoplantar psoriasis flare-ups entirely, certain strategies can help minimize their frequency and severity:

• Consistent use of prescribed medications
• Regular moisturizing to prevent skin dryness and cracking
• Protecting hands and feet from injury or excessive friction
• Managing stress through relaxation techniques
• Avoiding known triggers, such as certain foods or environmental factors

How often should individuals with palmoplantar psoriasis see their dermatologist? Regular follow-up appointments, typically every 3-6 months or as recommended by the healthcare provider, are crucial for monitoring disease progression and adjusting treatment plans as needed.

Developing a Skin Care Routine

A consistent skincare routine can help manage symptoms and improve overall skin health:

1. Gentle cleansing with non-irritating, fragrance-free products
2. Application of prescribed topical medications
3. Use of thick, emollient-rich moisturizers
4. Careful nail care to prevent infection and further damage
5. Sun protection to prevent UV-induced flare-ups

Can dietary changes help manage palmoplantar psoriasis? While research is ongoing, some individuals report improvement with anti-inflammatory diets. However, it’s essential to consult with a healthcare provider before making significant dietary changes, as nutritional needs vary among individuals.

The Importance of a Multidisciplinary Approach to Care

Managing palmoplantar psoriasis often requires a team of healthcare professionals working together to address various aspects of the condition:

• Dermatologists for skin-specific care and treatment
• Rheumatologists to manage any associated joint issues
• Mental health professionals to address psychological impacts
• Occupational therapists for adaptations in daily activities
• Nutritionists for dietary guidance

How can patients ensure they receive comprehensive care? Open communication with healthcare providers and advocating for referrals to specialists when needed can help ensure all aspects of palmoplantar psoriasis are addressed.

Patient Education and Self-Management

Empowering patients with knowledge and self-management skills is crucial for long-term success in managing palmoplantar psoriasis:

• Understanding the chronic nature of the condition
• Recognizing early signs of flare-ups
• Learning proper application techniques for topical treatments
• Developing strategies for managing symptoms in various situations
• Staying informed about new treatment options and research developments

By taking an active role in their care, individuals with palmoplantar psoriasis can work effectively with their healthcare team to achieve the best possible outcomes and maintain a good quality of life despite the challenges posed by this chronic condition.

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.