Psoriasis of Hands and Feet

Synonyms: psoriasis palmoplantaris

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. Crops of tiny yellow-brown pustules - known as palmoplantar pustular psoriasis (This has a controversial relationship with other forms of psoriasis. It has a psoriasiform pathology but is unusual in association with other types of psoriatic lesions and is dealt with elsewhere).

1.5% of the general UK population have psoriasis¹: a proportion of these, usually with psoriatic lesions elsewhere, will have psoriasis involving the feet and hands.

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

• Hyperkeratotic eczema
• Tinea pedis.

• 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 steroids (usually potent, due to the thick skin at this site).^2,3

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

Pain can prevent use of hands or walking.

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