What Is Palmoplantar Psoriasis?

Psoriasis is a chronic autoimmune inflammatory disorder of the skin. The most common type is a generalized plaque variant, which varies by patient in severity and where it appears on the body. Plaques are marked areas of raised, thickened skin.

Palmoplantar psoriasis is another variant of psoriasis that affects the skin of the palms of the hands and soles of the feet. Psoriasis affects approximately two to five percent of the population, with an estimated three to four percent of those patients suffering from palmoplantar psoriasis.

Palmoplantar psoriasis may appear at any age. Palmoplantar pustulosis, a more severe related condition that causes blister-like sores on the palms and soles, generally appears between the ages of 20 and 60 years.

Though palmoplantar psoriasis may not cover a large area of the body, research indicates that this type of psoriasis is especially debilitating due to its location. The feet and hands are necessary for everyday functioning, so disruption to daily life is increased compared to plaque psoriasis.

People with palmoplantar psoriasis rate their quality of life as much lower than those with general plaque psoriasis. Additionally, psoriasis of the feet affects one of the most sensitive parts of the body. Each step distributes the weight across the footís surface, causing pain and further irritation of symptoms.

What Causes Psoriasis?

Palmoplantar psoriasis is an autoimmune condition in which the immune system causes skin cells to develop too quickly. The cause is unknown, but speculated to be a combination of genetic and environmental factors. Sweat gland malfunction may also play a role. Smoking has been linked specifically to development of palmoplantar psoriasis, with most people with the disease (up to 95 percent) being current or former smokers. Nicotine damages the skin cells.

Certain triggers cause a flareup of palmoplantar psoriasis. The hands and feet are more exposed to environmental and chemical triggers, which may contribute to the development and progression of the disease. Some known triggers and risk factors include:

  • Allergen exposure
  • Chemical and physical irritant exposure, such as detergents
  • Infection
  • Smoking
  • Stress
  • Trauma

The existing presence of some diseases and conditions also heighten the risk of developing palmoplantar psoriasis, including:

  • Arthritis of the anterior thorax
  • Gluten sensitivity
  • Streptococcal tonsillitis
  • Thyroid disease
  • Type 1 diabetes
What Are Symptoms of Psoriasis?

While people with palmoplantar psoriasis may also have plaques elsewhere on the body, some may only have their palms and soles affected. Symptoms of palmoplantar psoriasis include:

  • Plaques
  • Redness
  • Scales (silvery appearance)
  • Itching and/or burning
  • Generalized pain
  • Cracking of the skin
  • Bleeding
  • Small pustules
  • Pitting, ridging, and thickening of the nails

Palmoplantar psoriasis can make it difficult to carry out everyday activities such as walking. Due to their location on the body, the lesions are hard to keep clean and hide, which may lead to social anxiety and embarrassment.

Palmoplantar pustulosis is genetically similar to palmoplantar psoriasis. Patients may have a combination of both pustules and plaques, with clusters of small yellow or white pustules next to the plaques.

Symptoms may not be present all the time, usually cycling through periods of remission and flareups. Certain triggers cause a flareup.

How Is Psoriasis Diagnosed?

A history and physical exam is performed by a healthcare provider. Psoriasis may often be diagnosed by appearance alone. However, a small skin sample or biopsy can rule out other inflammatory skin conditions, including:

How Is Psoriasis Treated?

At present, there is no specific therapy for palmoplantar psoriasis, which is often resistant to conventional psoriasis therapies. Finding an effective therapy that clears lesions with minimal adverse effects or contraindications is challenging and results vary from patient to patient.

The first-line therapy is usually a combined use of topical corticosteroids, topical vitamin D analogs (synthetic vitamin D rubbed on the skin) and a skin barrier repair cream. These topicals may also be used alone instead of in combination.

The second-line treatment option for palmoplantar psoriasis is phototherapy (light therapy). Exposure to natural forms of UVA and UVB light may help to slow the high speed of skin cell growth causing the psoriasis. PUVA (photochemotherapy) may also help. This treatment combines an oral medication called psoralen (P) and exposing the skin to UVA (long wave ultraviolet radiation). Other light therapies or lasers may be utilized.

In severe cases, systemic and biologic therapies may be considered, as they tend to be more successful than topical therapies alone. Systemic medications affect the entire body. Acitrecin, methotrexate and cyclosporine are some systemic drugs used to treat psoriasis. Biologic medications change the body’s immune response. Though they may help control psoriasis symptoms, they often have severe side effects and need constant monitoring.

Proper home care can also improve and help prevent symptoms and flareups, such as:

  • Keeping affected areas clean
  • Resting hands and feet often
  • Maintaining a healthy body weight
  • Quiting smoking
  • Limiting alcohol consumption
  • Avoiding bubble bath or shower gel
  • Using soap with moisturizer
  • Wearing vinyl gloves when performing any work with water, cleaners or gardening
  • Wearing 100 percent cotton socks
  • Avoiding shoes made from man-made materials
  • Using waterproof bandages for injuries

If you have psoriasis on your feet, request an appointment with Essex Union Podiatry. We can get you started on an effective treatment plan thatís right for you.

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Meet Our Doctors

The physicians of Essex Union Podiatry are experienced and dedicated professionals trained in various subspecialties of podiatry care. Click on the pictures below to learn more about our doctors.

Jason P. Galante, DPM,
DABPM, AASPS

Jason Galante, DPM, AASPS

Nancy A. Kaplan, DPM, MBA, AACHE, FACFAS

NANCY A. KAPLAN, DPM, FASPS

Sarah E. Haller, DPM, AACFAS

SARAH E. HALLER