Understanding Plantar and Palmar Psoriasis

Medically reviewed by Debra Sullivan, PhD, MSN, RN, CNE, COI on April 21, 2017Written by Neel Duggal on April 21, 2017

What is plantar and palmar psoriasis?

Psoriasis is a chronic skin condition that can occur on the skin in various places. If it’s on the palms of the hand, it’s typically called palmar psoriasis. Psoriasis on the soles of the feel is often called plantar psoriasis.

What are the symptoms?

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, called fissures.

Other common symptoms of psoriasis include:

  • silvery scales
  • dry, cracked skin
  • bleeding
  • an itchy, burning sensation
  • soreness
  • thickened, ridged nails
  • depressions or pits in nails
  • swollen, stiff joints

Pictures of palmar and plantar psoriasis

Who is at an increased risk for this condition?

Researchers aren’t sure what causes psoriasis specifically on the palms and soles, but there are factors that can increase your chances of developing psoriasis in general.

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

There are three genes associated with psoriasis:

  • NAT9
  • RAPTOR
  • SLC9A3R1

Having one, two, or all three genes significantly increases your chance of developing the condition, but it doesn’t necessarily mean you’ll develop it.

Other risk factors include:

  • stress, which can increase your risk for flare ups
  • smoking
  • compromised immune system
  • infections and cuts on your palms or soles

There may be a link between psoriasis and cardiovascular complications. One study from 2006 found an association between psoriasis and hypertension, diabetes, and hyperlipidemia. More research is needed to understand the relationship.

What are common treatments?

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

Your doctor may prescribe a topical treatment that you put directly on your skin, including:

  • vitamin D analogs, such as calcipotriene (Dovonex)
  • topical corticosteroids
  • topical retinoids
  • anthralin
  • coal tar products, which include creams, ointments, and gels that slow skin growth and ease itchiness
  • salicylic acid (Ionil, P&S, Salex, Sebulex, Selsun Blue)
  • moisturizers to reduce swelling and inflammation
  • calcineurin inhibitors

Common side effects of topical treatments include irritation, thinning of the skin, and dry skin.

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

  • UVB phototherapy
  • ultraviolet light (UV) from sunlight
  • Goeckerman treatment, which combines coal tar and UVB treatment
  • narrow band UVB therapy
  • excimer laser
  • photochemotherapy
  • psoralen plus ultraviolet A (PUVA)

If you have a severe case of psoriasis, your doctor may prescribe an oral medication to manage your symptoms, such as:

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

Your doctor will likely start out treating psoriasis with a milder treatment, such as topical creams and lifestyle changes. If you need it, your doctor 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 a plan that manages your symptoms. Some treatments can cause unexpected side effects. So stay in regular contact with your doctor and alert them of any symptoms or side effects you have.

Learn more: Psoriasis treatment »

What’s the outlook?

Plantar and palmar psoriasis share 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.

What lifestyle changes can help manage psoriasis? 

In addition to doctor-prescribed treatments, you can manage your psoriasis symptoms at home.

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

Learn more: 10 ways to treat psoriasis at home »

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