Palmoplantar psoriasis affects the palms of the hands and the soles of the feet. Psoriasis is an autoimmune condition that can flare up with exposure to certain triggers.

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.

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Palmoplantar psoriasis is a subtype of psoriasis and primarily affects the hands and feet. Bangmaha Art/EyeEm/Getty Images
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Palmoplantar psoriasis is a chronic inflammatory skin disease.
Santosh kumar parida/Shutterstock
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Over time, the skin becomes thickened and painful with dry cracks in the skin.
Photography courtesy of MCvanVeen/Wikimedia
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In severe cases, blisters and pustules can form on the hands and feet.
Photography courtesy of Masryyy/Wikimedia
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Steroids 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.
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It 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:

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:

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:

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:

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.

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