Synonyms: psoriasis palmoplantaris, psoriasis palmaris et plantaris.

Psoriasis predominantly affecting the palms and soles takes 3 forms:

1. Erythematous scaly plaques typical of psoriasis elsewhere in the body
2. More generalised thickening and scaling (keratoderma)
3. Palmoplantar pustulosis (palmoplantar pustular psoriasis)

Epidemiology

1.5% of the general UK population have psoriasis:¹ a proportion of these, usually with psoriatic lesions elsewhere, will have psoriasis involving the feet and hands.

Visual appearance

Presentation

• Red scaly plaques
• Hyperkeratotic areas
• Central palm or weight bearing areas of the soles
• Well demarcated
• Painful cracking and fissuring.

Differential diagnosis

• Hyperkeratotic eczema
• Tinea pedis
• Palmoplantar pustulosis (separate record)

Primary care management

• Classical psoriatic lesions can be treated with a vitamin D ointment (calcipotriol/Dovanex® or tacalcitol/Curatoderm®) or dithranol (Dithrocream®/Micanol®).
• In palm and sole psoriasis, both hyperkeratosis and inflammation are usually present and may require separate treatments:
  • Hyperkeratosis usually needs to be treated with a keratolytic agent such as 2% salicylic acid ointment BP.
  • This can be alternated morning and evening with a topical steroid (usually potent, due to the thick skin at this site).²

When to refer²

• Where there is diagnostic uncertainty
• For further patient counselling and education
• Where appropriate initial treatment has failed
• Where there is significant occupational disability

Complications

Pain can prevent use of hands or walking.

Prognosis

The condition tends to be persistent and, in some, quite resistant to treatment.