Understanding Palmar and Plantar Psoriasis

Palmar and plantar psoriasis usually cause the palms and soles to be partially or entirely covered in thickened, red skin. You may have sharp, noticeable borders where the skin changes from psoriasis patches to unaffected areas. You may also have painful cracks, which are called fissures.

Common symptoms of psoriasis include:

• silvery scales
• dry, cracked skin
• bleeding
• an itchy, burning sensation
• soreness
• thickened, ridged nails
• depressions or pits in the nails
• swollen, stiff joints, which are a symptom of psoriatic arthritis

Researchers are not sure what causes any of the various types of psoriasis, but they do know that the immune system is involved.

However, certain risk factors can make you more likely to develop psoriasis. There are also risk factors that can specifically increase your risk for palmar and plantar psoriasis.

A family history of the condition is one of the biggest overall risk factors for psoriasis. Having one parent with psoriasis increases your chance for developing it. Your risk increases significantly if both of your biological parents have psoriasis.

Certain individual genes are associated with psoriasis. Having at least one of these genes significantly increases your chance for developing the condition, but it does not necessarily mean you’ll develop it.

Factors that increase your risk for palmar and plantar psoriasis include:

• the presence of human leucocyte antigen-Cw6 (HLA-Cw6), which is an antigen and a gene variation
• smoking
• skin friction
• skin trauma, such as infections and cuts on your palms or soles
• other skin conditions, such as dermatitis of the hand

Palmar and plantar psoriasis can be diagnosed during a physical examination. In some cases, skin scrapings or a skin swab sample may be used in order to help rule out fungal infection.

Psoriasis is a chronic condition that cannot be cured. However, there are a variety of ways you can manage its symptoms.

Most treatments aim to curb inflammation, which helps reduce the rapid growth of skin cells.

Another type of treatment removes scales from the skin. Because the skin on your palms and soles is naturally thicker, palmar and plantar psoriasis may be more difficult to treat. Your doctor may need to adjust your treatment or give you a combination of treatments.

Topical treatments

Your doctor may prescribe topical treatments such as:

• moisturizers to improve the skin barrier
• vitamin D analogues, including calcipotriene (Dovonex, Sorilux)
• corticosteroids to reduce swelling and inflammation
• retinoids
• coal tar products, which include creams, ointments, and gels that slow skin growth and ease itchiness
• salicylic acid, which is found in products such as Salex, to help get rid of scales
• calcineurin inhibitors, including tacrolimus (Protopic) and pimecrolimus (Elidel)

Common side effects of topical treatments include:

• irritation
• thinning of the skin
• dry skin

The Food and Drug Administration (FDA) has actually approved calcineurin inhibitors for use in people with atopic dermatitis, which is sometimes referred to as eczema. However, doctors may still prescribe it for other conditions. This is an example of off-label drug use.

OFF-LABEL DRUG USE

Off-label drug use means a drug that’s approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that has not yet been approved.

However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs but not how doctors use drugs to treat their patients. So your doctor can prescribe a drug however they think is best for your care.

Phototherapy

Your doctor may recommend a treatment combination that adds light to your topical treatment. Examples of treatments that use light include:

• ultraviolet light (UV) from sunlight
• a psoralen drug plus ultraviolet A (PUVA), a combination also known as photochemotherapy
• ultraviolet B (UVB) phototherapy
• narrowband ultraviolet B (NB-UVB) therapy
• excimer laser therapy

Oral treatments

If you have a moderate to severe case of psoriasis, your doctor may prescribe an oral medication to manage your symptoms. Oral medications include:

• biologics that modulate the immune system
• cyclosporine (Gengraf, Neoral, Sandimmune), an immunosuppressant drug
• retinoids
• methotrexate (Trexall)
• apremilast (Otezla)

Side effects of these oral treatments include gastrointestinal problems and interactions with other drugs.

The bottom line about treatment

Your doctor will likely have you start with milder treatments, such as topical creams and lifestyle changes. If you need it, they may use stronger treatments such as UVB therapy and oral medications.

Managing psoriasis can be complicated because flare-ups are unpredictable. Your doctor may need to adjust your treatment plan multiple times before finding one that manages your symptoms.

Some treatments can cause unexpected side effects. Stay in regular contact with your doctor and alert them about any symptoms or side effects you have.

In addition to the treatments your doctor prescribes, you can manage your psoriasis symptoms at home.

• Take daily baths with bath oils, bath salts, or mild soaps.
• Use moisturizer and body oil on your skin, especially after bathing.
• Get a proper amount of sunlight. Talk with your doctor to determine what amount is ideal for your skin. Too little may not help areas where you have lesions. Too much, though, may increase your chances for developing skin cancer.
• Avoid psoriasis triggers such as smoking, stress, and alcohol consumption; seek ways to lower your risk for developing infections.
• Apply aloe vera to lesions several times a day for at least 1 month. There’s some evidence that it may help reduce redness and scaling caused by psoriasis.
• Get up to 5 grams of omega-3 fatty acids a day by eating certain foods (like fatty fish, walnuts, and flax) or taking fish oil supplements. These fatty acids may help reduce inflammation in people with psoriasis.

Palmar and plantar psoriasis have many commonalities with other types of psoriasis. Psoriasis is a common chronic condition, and it’s not contagious.

Your symptoms can be unpredictable in their intensity, but there are a variety of treatments you can use to manage them.