Palmoplantar psoriasis is also known as palmoplantar pustulosis. Sometimes it is associated with psoriatic scaly patches elsewhere in the body, otherwise limited to pustular eruption on the palms and soles. When it erupts without any psoriasis lesions, however, some dermatologists consider it as a separate entity of unknown origin.
The incidence of palmoplantar pustular psoriasis is very low considered to psoriasis and it usually affects adults between the ages of 50 to 60 years. About three fourth of patients affected are females.
Signs and Symptoms of Palmoplantar Pustular Psoriasis
The eruption appears in waves of grouped deep seated pus filled vesicles. The pus is sterile, i.e., no bacteria or any pathogenic organism is seen in the pus. When the eruption starts, there is a stinging and burning sensation, which becomes painful later on. The yellowish vesicles gradually resolve into dusky red crusts, when they become itchy. Itching can sometimes be very severe. Diffuse pustular psoriasis of the palms and soles heal and the superficial layer of skin peels off to reveal raw pink skin.
The eruptions of palmoplantar pustulosis involve both hands and feet usually, sometimes may be limited only to hands or feet. The pustules are more common on the sides of the palms, soles, heel, insteps and the flexor part (bending area) of the fingers and toes. In severe cases, the whole palms and soles can be involved.
Other Causes of Palmoplantar Pustular Eruptions
The following diseases have to be differentiated from palmoplantar pustular psoriasis:
- Fungal infection of palms and soles
- Pompholyx or dyshidrotic eczema
- Contact irritant dermatitis
- Contact allergic dermatitis
- Herpes Simplex infection(only on one side)
A potassium hydroxide slide preparation of the roof of the vesicles examined under microscope will rule out fungal infections in the absence of fungal hyphae and spores. Culture from the vesicle fluid will rule out infections. Herpes simplex vesicles are superficial, form on a red base, contain clear fluid and are grouped into a single area. When they are grouped on a finger this is known as herpetic whitlow, an occupational hazard of healthcare workers. Pompholyx vesicles are also deep seated, but contain clear fluid, and are common on the sides of fingers and finger tips. Contact dermatitis is usually uniform and also involves the dorsal aspect of the hands and feet, crusting and oozing is more wide spread, as is itching and burning sensation.
The normal palmoplantar psoriasis with the usual thick scaly plaques is different from the palmoplantar pustular psoriasis.
Normal Course of Palmoplantar Pustular Psoriasis
The skin lesion of palmoplantar pustular psoriasis persists for many years and is very resistant to treatment. Sometimes they disappear on their own, only to reappear again. Some patients notice that the psoriasis triggers initiate and exacerbate the palmoplantar pustular psoriasis too. In some individuals, in later years, psoriasis patches develop elsewhere on the body. Most patients with generalized pustular psoriasis have diffuse palmar and plantar psoriasis.
How to Treat Palmoplantar Pustular Psoriasis?
General psoriasis treatment guidelines apply to palmoplantar pustular psoriasis also.
Psoralen-ultra violet A (PUVA) soaks gives the best results in the treatment of palmoplantar pustular psoriasis. The affected hands and feet are immersed in a solution of 8-methoxypsoralen (10 mg in 1 liter of warm water) for about 15-20 minutes, dried, and then exposed to UVA rays using special hand and foot UVA light units for 5 minutes. Dark glasses should be worn during the treatment. Used along with super potent topical steroids or oral retinoids the efficacy of this phototherapy is increased.
Very resistant cases of palmar and plantar pustular psoriasis call for systemic treatment with methotrexate, cyclosporine or biological agents.
Reference
Disclaimer: The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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