Palmoplantar Psoriasis

Key Points
Type of psoriasis which typically affects the palms of the hands and/or soles of the feet
Exact cause of psoriasis is unknown, but seems to be caused by functional errors in the immune system
Consists of varying presentations, including red, scaly patches, scaling and thickening of skin, or small yellow to brown pustules which form in sheets

Palmoplantar psoriasis is a type of psoriasis which typically affects the palms of the hands and/or the soles of the feet. Its presentation of symptoms may vary. In some cases, it may appear quite like psoriasis, with the formation of scaly, red patches of skin. In others, skin on the palms or soles may see generalized thickening, also accompanied by scaling of the affected area (keratoderma). Additionally, the condition may present as small, yellow to brown pustules which form in sheets (palmoplantar pustulosis). The condition is typically chronic, and may be accompanied by dryness and cracking, which causes pain and limits movement.

The exact cause of psoriasis is unknown, but the condition seems to arise from functional errors in the immune system. Pustular presentations tend to be more common in persons who smoke.

Differential Diagnosis (Other conditions with similar appearance)
Pityriasis rubra pilaris
Secondary Syphilis
Parapsoriasis
Lichen simplex
Dermatitis

Diagnosis
Key Points
Diagnosis based on skin appearance
Skin biopsy may be performed to confirm diagnosis and to rule out other conditions

Palmoplantar psoriasis is typically diagnosed based on the appearance of the affected area. A skin biopsy may be performed to confirm the diagnosis and to rule out other, similar appearing conditions.

Treatment
In mild cases, topical therapies are typically used
*Severe cases may require more aggressive therapies

In milder cases, topical therapies such as use of emollient creams, coal tar preparations, creams containing urea or salicylic acid, and topical steroids are typically used to treat the condition. Severe cases may require more aggressive therapies, such as phototherapy and systemic treatments such as acitretin and methotrexate.