What is Palmoplantar Psoriasis?
Palmoplantar psoriasis is a type of psoriasis – a skin condition – that specifically affects the skin on your hands and feet. It can show up in different forms, such as thickened, rough skin, blisters, or a combination of both. There’s also a similar skin condition known as palmoplantar pustulosis, or pustular palmoplantar psoriasis. This condition is marked by small, harmless blisters and may either be a type of palmoplantar psoriasis or a separate condition altogether.
Both of these skin conditions are long-term and can make it difficult to perform everyday tasks, significantly impacting a person’s quality of life. Treatment has traditionally been tricky, but recent studies on biological therapies – treatment using substances that affect the body’s natural processes – have shown some encouraging results for managing palmoplantar psoriasis.
What Causes Palmoplantar Psoriasis?
We don’t exactly know what causes a skin condition called palmoplantar pustulosis. It seems to happen due to a mix of genetic factors, things in the environment, and your own behavior. One genetic factor is the human leukocyte antigen (HLA) Cw6. There could also be a connection to changes in the CARD14 gene and genes in the IL-19 subfamily. However, more research is needed to confirm this.
Things in your environment and lifestyle can also trigger this condition. These include smoking, exposure to irritants, friction, and traumatic events that happen repeatedly and affect the skin.
Interestingly, medications designed to treat certain types of cancer have been found to trigger skin outbreaks for some people. This mostly includes medicines known as anti-tumor necrosis factor-alpha agents.
People who have palmoplantar pustulosis often are people who smoke or used to smoke. Researchers think that nicotine, a substance found in tobacco, activates receptors in sweat glands. This can cause an inflammatory response, which contributes to the disease. Palmoplantar pustulosis has also been linked to thyroid disease, smoking, and arthritis of the chest.
Risk Factors and Frequency for Palmoplantar Psoriasis
Palmoplantar psoriasis, a variant of psoriasis, can affect people of all ages. However, the related condition of palmoplantar pustulosis usually starts affecting people from the ages of 20 to 60. It’s not clear whether palmoplantar psoriasis affects one gender more than the other, but palmoplantar pustulosis is more common in females, with the ratio of affected females to males being 8 to 2.
- Palmoplantar psoriasis can affect people of any age.
- Palmoplantar pustulosis generally affects people between the ages of 20 and 60.
- There isn’t clear data on whether one gender is more prone to palmoplantar psoriasis.
- Palmoplantar pustulosis is more common in women, with a female-to-male ratio of 8:2.
- While the exact number of cases is not known, palmoplantar psoriasis accounts for 3% to 4% of all the cases of psoriasis. Psoriasis, in general, affects 2% to 5% of the population.
Signs and Symptoms of Palmoplantar Psoriasis
Palmoplantar psoriasis and palmoplantar pustulosis are conditions that affect the skin, particularly on the palms of the hands and the soles of the feet. People who have these conditions often feel itchy and might experience pain and cracks in their skin. These symptoms can persist over time, with occasional worsening episodes that can be triggered by things like changing seasons, household tasks, or certain cleaning products. The skin conditions are more commonly seen in people who work in fields like farming, manual labor, or housekeeping. Sometimes, these skin problems can be a sign of an underlying issue with the joints.
In people with these conditions, the skin might look different upon examination. Some common changes include thickened skin patches, clusters of pus-filled blisters, or a combination of both. These skin changes most commonly appear symmetrically on both hands or feet. Redness, cracks, and scaly skin are also common. The skin on other parts of the body can be affected as well. In studies, about a third of patients have seen up to 10% of their body surface affected by these skin changes. The nails can also be affected, showing signs such as rough skin, thickened skin under the nails, and longitudinal ridges. Over time, the skin changes seen in palmoplantar pustulosis can develop into red, scaly, and cracked skin with underlying redness. Eventually, the skin changes resolve, leaving behind brown pigmentation.
Other skin conditions can also cause similar symptoms and should be considered when diagnosing these conditions. These include dyshidrotic eczema, contact dermatitis, pityriasis rubra pilaris, acquired palmoplantar keratoderma, and tinea pedis/manuum. There’s also a related condition called acrodermatitis continua of Hallopeau, which is characterized by painful, pus-filled skin changes surrounding the nails, which recur chronically.
Testing for Palmoplantar Psoriasis
The first step to diagnosing any illness is a detailed history and physical examination from your doctor. In the case of a red and scaly rash on the palms of your hands and/or the soles of your feet, they might perform a test with a substance called potassium hydroxide (KOH). This test can help rule out skin infections. Sometimes, your doctor may also need to take a small sample of your skin (a biopsy) for further examination. This is because the rash caused by a condition called palmoplantar psoriasis can look very similar to rashes caused by skin allergies or fungal skin infections.
The sample of your skin will be carefully examined under a microscope. Certain signs like excess skin cell production (parakeratosis), loss of specific skin layers, abnormal increase in skin cells (psoriasiform epidermal hyperplasia), and pus-containing skin bumps (Munro microabscesses) help confirm a diagnosis of psoriasis. In palmoplantar psoriasis, your doctor might also see a mix of normal and abnormal skin cell production.
Your doctor might also order specific blood tests like C-reactive protein (CRP) and uric acid levels. These are often increased if you have a type of palmoplantar psoriasis that causes tiny, pus-filled bumps on the skin (the pustular variant).
Moreover, your doctor could use different tools to measure the severity of your skin condition and to monitor how well you’re responding to treatment. Two such tools are the Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI) and the Palmoplantar Psoriasis Area and Severity Index (PPASI). Other tools, such as the Palmar-Plantar Quality-of-Life Index, could be used to assess how much the condition is affecting your everyday life.
Treatment Options for Palmoplantar Psoriasis
Historically, there’s been little data on how to treat palmoplantar psoriasis, a type of psoriasis that affects the palms of the hands and the soles of the feet. This is because clinical trials often exclude these patients since less than 10% of their body surface area is usually affected. However, recent years have seen more information come out, particularly regarding biologic agents – medicines that are made from living organisms and are used to target specific parts of the immune system.
One thing we know is that many patients will need a system-wide treatment due to the stubborn nature of these skin diseases. In fact, one study found that only 27.4% of patients saw improvement with creams applied directly to the skin, while the rest needed systemic treatments. The reason for this is that the skin of the soles and palms is thicker, acting as a barrier to medications.
Initially, treatment usually involves strong corticosteroid creams applied twice a day, with the frequency gradually reduced over time. These can be combined with, or alternated with, a medication called calcipotriene, which should not be used with salicylic acid as it can deactivate the medicine. If this doesn’t work, doctors may recommend a medication called acitretin, which can improve symptoms but shouldn’t be used during pregnancy due to potential harm to the baby.
If the first-line treatment isn’t effective, the next options could be light therapy or more systemic treatments like methotrexate and cyclosporine. Light therapy involves exposing the skin to ultraviolet light under medical supervision. Methotrexate and cyclosporine are medications that can alter the way your immune system works. Like acitretin, methotrexate should not be taken during pregnancy, while cyclosporine can be used with caution.
There’s also some evidence that laser and other light therapies may work. These newer treatments require less cumulative dose to ease symptoms, meaning fewer treatments are needed overall.
Biologic medicines are another option but are generally reserved for patients who haven’t had success with topical or other systemic medications. These drugs, which include options like etanercept, infliximab, adalimumab, ustekinumab, secukinumab, and ixekizumab, work by selectively targeting certain parts of the immune system. Several of these medications have shown significant improvement in research studies.
However, it’s important to remember that many people with psoriasis often have other health issues such as kidney failure, liver disease, cancer, or heart failure. These can make them more susceptible to side effects from medications. So, it’s crucial to carefully weigh up the potential benefits and risks of each treatment option for each individual patient.
In summary, the treatment that works best for symptom relief appears to be a combination of oral retinoids (a type of medication derived from vitamin A), with or without light-activated therapy, plus low dose corticosteroids and cyclosporine.
What else can Palmoplantar Psoriasis be?
Common skin conditions that can cause discomfort include:
- Eczema
- Fungal infection
- Xerosis (dry skin)
- Dermatitis (skin inflammation)
What to expect with Palmoplantar Psoriasis
Palmoplantar psoriasis, a type of skin condition, can be quite challenging to manage. The treatments usually take a while to show results, may cause side effects, and are often expensive. As a result, this can significantly affect the life quality of patients as they may experience discomfort or distress.
For most patients, it may take many months of a combined treatment approach before they start seeing improvements. On top of this, patients often deal with other health conditions that can further complicate their skin condition and affect their treatment outcomes.
