PSORIASIS OF THE PALMS AND SOLES

By Gary M. White, MD

Psoriasis of the palms


Psoriasis is not uncommon on the palms and soles.

Clinical

Psoriasis may affect the palms and soles in a variety of ways.

Well-defined areas of redness and scaling of the palms and/or soles may occur in psoriasis. Look fornail changes (e.g. pits) or psoriasis elsewhere. It may initially resemble hand dermatitis and later evolve into more typical psoriasis.  

Treatment

It has been noted that patients with palm plantar psoriasis have a greater reduced quality of life compared with patients with moderate to severe plaque type psoriasis [JAAD 2014;71;623-32]. Thus therapy should be relatively aggressive and clinicians should not shy away from offering systemic treatments.

Potent topical steroid (e.g.class I) should be given initially. A steroid-impregnated tape (e.g. Cordran) may be particularly useful on the palms overnight. Combination with topical tazarotene or calcipotriene may be beneficial. For resistant cases, hand-foot soak UVB should be tried and if that fails, systemic treatments, e.g. apremilast, methotrexate, biologics, etc. may be given.

For example, secukinumab at a dose of 300 mg subcutaneous was shown very effective [JAAD 2017;76;70].

Additional Pictures

Psoriasis of the sole

Hyperkeratotic plaques and fissures are common.
Psoriasis of the toe Psoriasis of the heel

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