Palmoplantar psoriasis usually affects the palms of the hands and the soles of the feet specifically.
The Centers for Disease Control and Prevention (CDC) estimate that 3.1 percent of American adults aged 20 to 59 have some form of psoriasis.
The World Health Organization (WHO) reported that the prevalence of psoriasis has reached 11.4 percent in some countries. The WHO term psoriasis a "serious global threat."
Who gets palmoplantar psoriasis?
Psoriasis is a common autoimmune condition with varying symptoms and severity.
The symptoms and severity of psoriasis vary. In severe psoriasis, scaly patches or plaques on the skin can affect most of the body and can be extremely painful.
A severe case of psoriasis can be disabling and cause social stress. However, some people have few noticeable symptoms.
According to the American Academy of Dermatology, 20 percent of psoriasis cases in the United States are moderate to severe, involving at least 5 percent of the skin.
A person will usually develop their first flare of psoriasis between the ages of 15 and 35 years, but it may develop at any age. Caucasians over the age of 50 appear to have the highest chance of developing psoriasis.
The exact causes of psoriasis remain unclear, but research suggests that genetics play a role.
However, while around 10 percent of Americans inherit at least one psoriasis- linked gene, only around 3 percent develop the condition. This suggests that factors other than genetics may have an impact.
Palmoplantar psoriasis appears to be one of the more common forms of the condition. One study suggests that it accounts for 14 percent of all psoriasis cases.
People with palmoplantar psoriasis usually develop symptoms on the palms of their hands and the soles of their feet. Hands and feet tend to be more exposed to environmental and chemical triggers, and this may play a role in the development and progression of the condition.
One study found that industrial workers had a higher chance of developing palmoplantar psoriasis, possibly due to exposure to chemicals, irritants, injury, and infection.
People with plaque psoriasis typically develop well-defined areas of raised, red, scaly patches of thickened skin with a silvery tinge. Plaques can feel painful, itchy, and sometimes feel as if they are burning. Some may crack and bleed.
Palmoplantar psoriasis can occur as part of a more generalized plaque-type condition, or it may be limited to the palms of the hands and the soles of the feet.
Palmoplantar sores may appear as typical psoriasis plaques or as more unified, less obviously inflamed thickenings of the skin called acquired keratodermas.
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 hide them. This can lead to embarrassment and social anxiety.
At least three separate disorders are related to palmoplantar psoriasis:
- Palmoplantar pustulosis
- Palmoplantar pustular psoriasis
- Acral pustulosis
Each of these conditions involves clusters of white pustules alongside normal psoriasis plaques. In arcal pustulosis, these pustules extend to the tips of the fingers or toes.
Risk factors and triggers
Stress may be a trigger for palmoplantar psoriasis.
Environmental risk factors and lifestyle choices may increase the likelihood of developing palmoplantar psoriasis.
- Injury or wounds
- Severe sunburn
- Bug bites
- Chemical and physical irritants
- Skin infections
- Common bacterial infections such as pneumonia or strep throat
- Viral infections such as HIV
- Inflammatory conditions such as bronchitis, tonsillitis
- Autoimmune conditions
- Heavy alcohol consumption
- Cold weather or abrupt changes in weather
Medications and other conditions that may trigger psoriasis include:
- Indomethacin and other inflammatory medications
- High blood pressure and general heart medications
- Sudden withdrawal from oral corticosteroids or systemic steroids
- Salicylates, iodine, trazodone, penicillin, hydroxychloroquine, calcipotriol
- Calcium deficiency
People with psoriasis may develop other serious medical conditions. Those with severe psoriasis may have a 58 percent higher chance of a major cardiovascular event, and a 43 percent higher chance of a stroke.
The National Institute of Health link a number of medical conditions to psoriasis.
- Other autoimmune conditions such as Crohn's, celiac, or inflammatory bowel disease
- Type 2 diabetes
- High blood pressure
- Hardening of the arteries
- Liver disease
- Kidney disease
- Metabolic syndrome
- Parkinson's disease
- Eye infections
When to see a doctor
If psoriasis flares up and causes discomfort, a doctor can prescribe medication to reduce the symptoms.
Early treatment can help to prevent symptoms of palmoplantar psoriasis from becoming severe or disabling.
When diagnosing the condition, the doctor may take a small skin sample or biopsy to rule out other skin inflammatory conditions such as contact dermatitis. Often, the doctor can diagnose psoriasis by appearance alone.
There are many therapies that may lessen the symptoms of palmoplantar psoriasis.
There is no cure for psoriasis or palmoplantar psoriasis, but cases can be treated according to their symptoms and severity.
Most treatment options for palmoplantar psoriasis involve light therapy and topical or systemic medication, either by mouth or by injection, or a combination.
A drug which works for one patient may have adverse effects on another. Some treatment options, especially topical corticosteroids, may become less effective over time. It is important for patients to keep in contact with their doctor in order to find a suitable solution.
Medicated creams and ointments for palmoplantar psoriasis include:
- Salicylic acid
- Coal tar
- Topical corticosteroids
- Vitamin D3
- Synthetic vitamin D, such as calcipotriol (Dovonex) and calcitriol (Rocaltrol)
- Tacrolimus (Prograf) and pimecrolimus (Elidel)
- Tazarotene, a vitamin A derivative
Systemic treatments for psoriasis can suppress the immune system and reduce cellular turnover. Common options include:
A number of biologic response modifiers look promising for helping to control severe cases of psoriasis. These treatments require monitoring for infection, side effects, and efficacy.
- Interleukin (IL)-12/23 antagonist ustekinumab
- IL-17 antagonists like secukinumab
- Anti-tumor necrosis factor alpha antagonists like infliximab, etanercept, and adalimumab
- The phosphodiesterase 4 inhibitor apremilast
Photo or light therapy can be used for psoriasis treatment independently or with medication. Exposure to natural forms of narrow and broadband ultraviolet B and A light may decrease the speed of skin cell growth.
Phototherapy involves routine exposure of the skin to specific doses of natural or artificial ultraviolet light.
Patients are advised to start by spending 5 to 10 minutes each day in the sun. If the skin responds well, they can increase exposure time by 30 seconds a day. Sunscreen should be applied to nonaffected areas.
Palmoplantar psoriasis symptoms may respond well to a treatment process known as PUVA. This treatment combines natural light exposure and the drug psoraen oral photosensitizing medication.
Prevention and outlook
Palmoplantar psoriasis tends to be a long-term condition. There is no cure, but combination therapies can lessen symptoms.
Home remedies that may help to reduce pain and discomfort include lukewarm baths with mild additives like colloidal oatmeal. A person with psoriasis should choose mild soaps and bath oils that are dye- and fragrance-free.
After bathing, an individual should blot their skin dry with a soft, clean cloth to avoid irritation. They should then apply moisturizer to the damp skin. People with severe cases of psoriasis may need to reapply the moisturizer several times throughout the day.
Dry or cold weather normally increases the need for moisturizers. Oils, ointment, lotions, and creams can help. Moisturizers with naturally soothing, anti-inflammatory properties like aloe vera may relieve symptoms.
Humidifiers may also decrease dry skin.
Anti-inflammatory and skin-healthy oral or topical supplements like fish oils, barberry, tea tree oil, Epsom or Dead Sea salts, and apple cider vinegar may ease discomfort.
When applied topically, capsaicin, the spicy ingredient in chili peppers, may help alleviate itching and burning.
Preventive measures involve avoiding triggers.
Any factor that places stress or alters the metabolic or immune system may trigger a flare.
Alcohol consumption, smoking, stress, and obesity are all considered psoriasis triggers. Alcohol can also decrease the effectiveness of treatment options.