Living With Palmoplantar Psoriasis

Palmoplantar psoriasis is a chronic, recurring condition that affects the palms of hands and soles of feet. It looks similar to other types of skin conditions, such as hand dermatitis, but the appearance of psoriasis lesions elsewhere on the body is an indicator of psoriasis. It varies in severity, and may limit a person’s ability to complete their daily activities. It most often affects adults, and is sometimes hereditary.
Palmoplantar psoriasis is characterized by a few different symptoms:
The appearance of red patches of skin topped with scales typical of psoriasis on the palms and elsewhere on the body
Thickening and scaling of the skin accompanied with the formation of deep, painful fissures on the palms and soles
Palmoplantar pustulosis - the appearance of deep, yellowish pustules

Although rare, Pustular Psoriasis is a very serious condition which affects the body both internally and externally. Palmoplantar psoriasis is a type of Localized pustular psoriasis that affects the palms of hands and soles of feet. There are two types of Localized Pustular Psoriasis: Acropustulosis, which occurs only on the tips of the fingers, and Palmo-plantar pustulosis, which only occurs on the palms of hands and/or the soles of feet.
In general, Palmo-Plantar Pustulosis occurs in people between 20 and 60 years old, and may be triggered by infection and/or stress. It has also been found to affect females more than males. As with Generalized Pustular Psoriasis, Palmo-Plantar Pustulosis occurs in a cyclical pattern, with new pustules occurring after a period of low-to-no activity.

The "fleshy" areas of the hands and feet (base of thumb and/or sides of heels) develop large, yellowish pustules - about the size of a pencil eraser, or .5 centimeters. These Pustules have a studded pattern over reddened patches of skin, and contain non-infectious pus (white blood cells). Throughout the next 7 to 14 days, the Pustule will become smaller, lose it's yellowish color, and become topped with a brown scale of skin. Usually, the disease becomes much less active for a time after peeling.
Palmoplantar pustulosis had been found to occur more frequently in people who smoke or used to some tobacco. The causes of flare-ups are not known, but pressure and rubbing will make it worse. The effects on overall health are small, but it can be very uncomfortable and painful.

Palmo-Plantar Pustulosis is stubborn to treat, but the symptoms can be controlled. Although it often affects smokers, quitting smoking does not always help clear the disease. Topical treatments, such as corticosteroids, are usually prescribed first. PUVA, acitretin (Soriatane), methotrexate or cyclosporine (Neoral) sometimes must be used to clear this form. Combination treatment with PUVA and Soriatane (called RePUVA) may also be effective. No one treatment will work for everyone and most people will have to try several types of treatment in order to find one that works.

Acrodermatitis is a form of Palmo-Plantar Pustulosis which is characterized by painful, potentially disabling, skin lesions on the tips of fingers and sometimes the tips of the toes. The nails may become deformed, and this type of Palmo-Plantar Pustulosis can change and damage the bone in the affected area.

Acropustulosis occasionally starts after the skin is injured or infected. This form has traditionally been hard to treat. Tar preparations under occlusion help some patients. Oral retinoid drugs, such as acitretin (Soriatane), may help clear the lesions and restore the nails. PUVA may also be used.