Palmoplantar Psoriasis Treatment, Symptoms, and Causes

Palmoplantar Psoriasis: Treatment, Symptoms, and Causes

Understanding Palmoplantar Psoriasis

Palmoplantar psoriasis, a form of psoriasis that specifically affects the palms of the hands and the soles of the feet, is an autoimmune condition characterized by inflamed, scaly patches on the skin. These patches can be both itchy and painful, often cracking and bleeding due to friction from daily activities such as walking or working. Although it can occur independently, palmoplantar psoriasis is also frequently found alongside psoriasis affecting other parts of the body. Unfortunately, this type of psoriasis tends to be more resistant to traditional treatments, though newer biologic medications have shown promise in managing it.

Visual Symptoms of Palmoplantar Psoriasis

Palmoplantar psoriasis manifests in similar ways to plaque psoriasis seen on other areas of the body. The key symptoms include:

• Raised, thickened patches of skin

• Red, dry, and peeling skin

• Silvery-white flakes that shed from the affected areas

In addition to these symptoms, individuals may also experience:

• Itching and burning sensations

• Discomfort or pain

• Cracking or bleeding when the skin is rubbed or scratched

Factors That Aggravate Palmoplantar Psoriasis

Palmoplantar psoriasis tends to flare up periodically, often triggered by environmental or physical stressors. For instance, tasks such as washing dishes can dry out the skin, while prolonged standing or walking can cause heat and friction, exacerbating the condition. These flare-ups are often spontaneous, with periods of remission followed by sudden aggravation.

Related Conditions and Co-occurring Health Issues

Palmoplantar psoriasis may co-occur with other forms of psoriasis. A related condition, acrodermatitis continua of Hallopeau (ACH), is a form of pustular psoriasis that results in pus-filled lesions on the hands, feet, and other areas. Additionally, more than half of individuals with palmoplantar psoriasis experience concurrent nail psoriasis, which can cause thickening, lifting, and discoloration of the nails.

More than one-third of those with palmoplantar psoriasis also develop psoriasis in other areas of the body. This can significantly impact the quality of life, particularly since the hands and feet are integral to most daily activities.

Triggers of Palmoplantar Psoriasis

Although the exact cause of palmoplantar psoriasis remains unclear, it shares the same underlying causes as other forms of psoriasis. Psoriasis is an autoimmune condition where the body’s immune system mistakenly attacks healthy skin cells, known as keratinocytes. This triggers rapid skin cell turnover, leading to the formation of thick, scaly plaques.

The condition is believed to be caused by a combination of genetic factors and environmental triggers. Common triggers for palmoplantar psoriasis include:

• Psychological stress

• Skin injuries or excessive sun exposure

• Infections, particularly strep throat or skin infections

• Extreme temperatures (both cold and hot)

• Certain medications, such as beta-blockers or lithium

A unique phenomenon associated with palmoplantar psoriasis is the Koebner response, where plaques appear along the lines of skin trauma, such as from ill-fitting shoes or work gloves.

Diagnosing Palmoplantar Psoriasis

There is no definitive lab test for diagnosing palmoplantar psoriasis. However, healthcare providers typically diagnose the condition based on physical symptoms, a patient’s medical history, and any co-occurring issues such as nail involvement or a history of autoimmune diseases. In some cases, a skin biopsy may be performed to examine the skin cells under a microscope, confirming the diagnosis.

Other Conditions to Rule Out

When diagnosing palmoplantar psoriasis, it’s important to rule out other skin conditions that may mimic its symptoms. These include:

• Contact dermatitis (skin reactions to irritants)

• Eczema (atopic dermatitis)

• Hand, foot, and mouth disease (a viral infection)

• Palmoplantar keratoderma (a genetic condition causing thickened skin)

• Pityriasis rubra pilaris (an inflammatory skin condition)

• Secondary syphilis (which can cause skin outbreaks)

• Tinea manuum and tinea pedis (fungal infections like athlete’s foot)

Managing Palmoplantar Psoriasis

Although palmoplantar psoriasis cannot be cured, its symptoms can be managed through various treatments. These treatments aim to alleviate symptoms, prevent flare-ups, and improve overall skin health. Options for management include:

Mild to Moderate Cases:

For less severe cases, topical treatments are often effective. These include:

• Emollient moisturizers to combat dryness and reduce itching

• Salicylic acid in creams, soaps, and foot balms to break down thickened skin

• Urea creams to soften the skin

• Coal tar preparations to slow down skin growth

• Anti-itch creams with ingredients like camphor or menthol

• Calcipotriene (a vitamin D derivative) to reduce skin cell production and inflammation

• Topical corticosteroids to reduce inflammation

Moderate to Severe Cases:

For more persistent or severe cases, systemic treatments may be necessary. These include:

• Methotrexate, an oral medication that slows cell production

• Soriatane (acitretin), a retinoid for resistant psoriasis

• Bathwater PUVA, a treatment involving ultraviolet light therapy

In certain cases, biologic medications may be prescribed to target specific immune system pathways involved in the disease.

Expert Tips for Managing Palmoplantar Psoriasis

To manage palmoplantar psoriasis more effectively:

• Use moisturizers consistently to reduce dryness and discomfort.

• Protect your hands and feet from unnecessary friction or trauma, such as wearing comfortable shoes.

• Limit exposure to triggers like extreme temperatures or infections.

Conclusion

Palmoplantar psoriasis is a chronic, often challenging condition that affects the hands and feet, leading to discomfort, pain, and a reduced quality of life. While it cannot be cured, with proper management, individuals can reduce the severity of symptoms and improve their overall quality of life. Treatments range from topical solutions to more advanced systemic therapies, and with the right approach, flare-ups can be minimized.

Frequently Asked Questions

• What Does Palmoplantar Psoriasis Look Like? The affected areas show raised, thickened patches of red, dry, peeling skin with silvery-white flakes.

• What Causes Palmoplantar Psoriasis? It is caused by a combination of genetic predisposition and environmental factors, including stress, skin injuries, and infections.

• How Can Palmoplantar Psoriasis Be Treated? Treatment options include moisturizers, topical corticosteroids, and systemic medications, depending on the severity of the condition.

Key Takeaways

• Palmoplantar psoriasis affects the hands and feet, causing discomfort and skin changes.

• Treatment focuses on reducing symptoms and preventing flare-ups.

• A combination of topical and systemic therapies can be used for effective management.