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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).
Epidemiology

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.

Visual appearance

FOOT PSORIASIS -SHOWING HYPERKERATOSIS (DIS45.jpg)

Presentation
  • Red scaly plaques
  • Hyperkeratotic areas
  • Central palm or weight bearing areas of the soles
  • Well demarcated
  • Painful cracking and fissuring.
Differential Diagnosis
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 steroids (usually potent, due to the thick skin at this site).2,3
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.


Document References
  1. Gelfand JM, Weinstein R, Porter SB, et al; Prevalence and treatment of psoriasis in the United Kingdom: a population-based study. Arch Dermatol. 2005 Dec;141(12):1537-41. [abstract]
  2. British Association of Dermatologists; Clinical Guidelines; Psoriasis (2006)
  3. Recommendations for the initial management of psoriasis, Primary Care Dermatology Society (2003)

Internet and Further Reading Acknowledgements EMIS is grateful to Dr Chloe Borton for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 4083
Document Version: 20
DocRef: bgp26009
Last Updated: 22 Mar 2007
Review Date: 21 Mar 2009
















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PS - Health and Poverty

Perhaps the biggest cause of ill health in the world is poverty. Help to Make Poverty History. For example, why not lend some of your money to disadvantaged communities to enable them to trade their way out of poverty through schemes such as Shared Interest.

See also MAKEPOVERTYHISTORY North East for details and links to campaigns against poverty.

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