What's to know about palmoplantar psoriasis?
It can appear almost anywhere on the body, including the hands and feet.
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 have times of remission and then a flare. Certain triggers can cause a flare.
Read on to find out more about how to recognize this condition, what causes it, and what you can do about it.
Palmoplantar psoriasis can cause red, scaly patches to appear on the hands and feet.
Palmoplantar psoriasis can occur as part of more general plaque psoriasis, or it may only affect the palms of the hands and the soles of the feet.
The symptoms include:
- well-defined areas of raised, thickened skin
- redness and scaling
- an itching and burning sensation
- 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.
A study published in 2015 found that it affected both the hands and feet in just over half of 237 participants.
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.
Research published in 2016 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, 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.
People do not know exactly what causes palmoplantar psoriasis, but it probably happens because of a combination of genetic and environmental factors.
A problem with certain sweat glands could also play a role.
Risk factors and triggers
Environmental risk factors and lifestyle choices may increase the likelihood of developing 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
People with the following conditions may also have a higher chance of getting palmoplantar psoriasis:
- thyroid disease
- arthritis of the anterior thorax
- type 1 diabetes
- a gluten sensitivity
- streptococcal tonsillitis
Between 10 and 25 percent of people with palmoplantar psoriasis have chronic plaque psoriasis, according to DermNet NZ.
Most people with the condition either smoke or have previously smoked.
One study in 2013 found that 95 percent of people with palmoplantar psoriasis were former or current smokers.
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, people with psoriasis often have a higher chance of developing:
- Crohn's disease
- hardening of the arteries
- type 2 diabetes
- liver disease
- kidney disease
- metabolic syndrome
- eye infections, such as uveitis
People with palmoplantar and other types of psoriasis also have a higher risk of psoriatic arthritis, which affects the joints.
When to see a doctor
A doctor can prescribe medication to reduce discomfort during a psoriasis flare.
To diagnose the condition, the doctor will look at the symptoms and ask the person about their medical history.
Often, the doctor can diagnose psoriasis by appearance alone.
A doctor will examine the hands and recommend a treatment, which may combine corticosteroids, vitamin D, and light therapy.
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 medications
- systemic medication, which affects how the body works
- light therapy
- biologic treatments
A person may have to work with their health provider and try several treatments to find a suitable one.
Second-line treatment is light therapy.
Exposure to natural forms of UVB and UVA light may help to slow down the speed at which skin cells grow.
The doctor may recommend:
- Starting with 5 to 10 minutes each day in the sun
- Increasing exposure time by 30 seconds a 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 psoraen oral photosensitizing medication.
Other light therapies include NB-UVA or a monochromatic excimer laser.[DS10]
Systemic treatments affect the whole body.
Psoriasis happens when the immune system does not work properly, and skin cells grow too quickly. A systemic mediation can help prevent this.
A Cochrane review notes that doctors prescribe the following treatments for psoriasis:
Biologics are targeted therapies that can change the body's immune response. They may help to control the symptoms of psoriasis when other treatments have not worked.
However, some of these can have severe side effects. A doctor will need to monitor the person's progress.
Examples of biologic drugs include:
- Interleukin (IL)-12/23 antagonist ustekinumab
- IL-17 antagonists, such as secukinumab
- phosphodiesterase 4 inhibitors, such as apremilast
Some home remedies may help to reduce pain and discomfort.
Bathing and soaking
Bathing can relieve symptoms, but be sure to choose the right temperature and products.
- Soak the hands and feet in lukewarm water.
- Add a soothing natural substance, such as oatmeal or Dead Sea salts.
- Use mild soaps and bath oils without added colors or fragrance.
- Blot the skin dry after soaking with a soft, clean cloth, to avoid irritation.
- Apply moisturizer to the damp skin.
Humidity and moisture
Moisturizing the hands with a suitable cream can reduce itching and discomfort.
Tips for reducing dryness include:
- using a humidifier
- moisturizing several times a day especially in dry weather
A doctor or pharmacist can advise about a suitable lotion, oil or cream for moisturizing.
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.
Supplements and alternative treatments
The National Psoriasis Foundation suggest 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.
- Epsom or Dead Sea salts: Add these to lukewarm water to soak the hands or feet.
- Oats: You can add these to a soak or a bath.
- 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.
- Capsaicin: Some people find that applying a cream containing the spicy ingredient in chili peppers to the skin may help reduce itching and burning.
- Mahonia Aquifolium: Also known as Oregon grape, applying a 10-percent topical cream may help reduce mild to moderate symptoms of psoriasis.
- Turmeric: Adding this spice to food or taking supplements may help with some types of psoriasis.
Ask a health professional before using any of these, to make sure they are safe and suitable for you to use.
Apply a small amount to a small area of skin to check your reaction, in case you have an allergy or the treatment makes symptoms worse.
Prevention and outlook
Palmoplantar psoriasis tends to be a long-term condition. There is no cure, but treatment can help control symptoms.
Since genetic factors are likely to play a role, it can be difficult to prevent psoriasis, but the following may help:
- controlling body weight
- stop smoking
- managing stress
- limiting alcohol consumption
- reducing direct exposure to detergents and chemical
If you can pinpoint what causes a flare for them, this can help you to avoid the trigger.