Psoriasis is a non-contagious condition that affects the skin and the joints. It appears almost anywhere on the body; however, it most frequently affects the arms, legs, scalp, lower back, and upper torso. Palmoplantar Psoriasis often affects the palms of the hands and the soles of the feet. According to the Centers for Disease Control and Prevention (CDC), it is estimated that 3.1 percent of American adults aged 20-59 have some form of psoriasis.
The World Health Organization (WHO) reported that the prevalence of psoriasis has reached 11.4 % in many countries.
Is it Severe?
The symptoms psoriasis vary. In severe psoriasis, scaly patches or plaques on the skin can affect most of the body and it can be extremely painful. A severe case of psoriasis can be disabling and cause social stress. But some people have few noticeable symptoms.
American Academy of Dermatology reported that 20 % of psoriasis cases in the United States are moderate to severe, involving at least 5% of the skin. A form of inflammatory arthritis, psoriatic arthritis, can develop alongside skin plaques in at least 10- 20 % of cases.
A person often develops their first flare of psoriasis between the ages of 15-35 years; however, it might develop at any age. Caucasians over the age of 50 may appear to have the highest chance of developing psoriasis.
Those who with metabolic disorder, which is a condition characterized by obesity, diabetes, and high blood pressure, can also develop psoriasis
What’s Causing psoriasis?
The exact causes of psoriasis is still unclear; however, research suggests that genetics play a role.
while around 10% of Americans inherit at least one psoriasis- linked gene, only around 3% develop this condition. This suggests that there are other factors than genetics may have an impact.
Palmoplantar psoriasis is considered as one of the more common forms of the condition. A study suggests that it accounts for 14% of all psoriasis cases.
People with palmoplantar psoriasis often develop symptoms on the palms of their hands and the soles of their feet because hands and feet tend to be more exposed to environmental and chemical triggers, and this can play a role in the development and progression of the condition.
Another study found that industrial workers had a higher chance of developing palmoplantar psoriasis due to exposure to chemicals, irritants, injury, and infection.
What are the Symptoms of palmoplantar psoriasis?
People with plaque psoriasis develop well-defined areas of raised, red, scaly patches of thickened skin with a silvery tinge. Plaques may feel painful, itchy, and sometimes feel as if they are burning. Some may crack and bleed.
Palmoplantar psoriasis can considered as part of a more generalized plaque-type condition, or it may be limited to the palms of the hands and the soles of the feet. Palmoplantar sores can appear as typical psoriasis plaques or as more unified, less obviously inflamed thickenings of the skin that called acquired keratodermas.
Palmoplantar psoriasis can make it hard to carry out everyday activities such as walking. The location of symptoms can make it difficult to keep the lesions clean and to hide them. This may lead to embarrassment and social anxiety.
There are at least three separate disorders that are related to palmoplantar psoriasis:
- Palmoplantar pustular psoriasis
- Palmoplantar pustulosis
- Acral pustulosis
All of them involve clusters of white pustules alongside normal psoriasis plaques. In arcal pustulosis, these pustules will extend to the tips of the fingers or toes.
What are the Risk factors and Triggers of palmoplantar psoriasis?
- Stress can be a trigger for palmoplantar psoriasis.
- Environmental risk factors and lifestyle choices may increase the likelihood of developing palmoplantar psoriasis.
These triggers can include:
- Injury or wounds
- Stress
- Severe sunburn
- Chemical and physical irritants
- Bug bites
- Skin infections
- Allergens
- Common bacterial infections such as pneumonia or strep throat
- Smoking
- Viral infections
- Inflammatory conditions
- Autoimmune conditions
- Heavy alcohol consumption
- Obesity
- Cold weather or abrupt changes in weather
Medications that may trigger psoriasis include:
- Lithium
- Anti-malarials
- Indomethacin and other inflammatory medications
- Sudden withdrawal from oral corticosteroids or systemic steroids
- High blood pressure and general heart medications
- Salicylates, iodine, trazodone, penicillin, hydroxychloroquine, calcipotriol
- Calcium deficiency
- Complications
People with psoriasis might develop other serious medical conditions. Those with severe psoriasis may have a 58% higher chance of a major cardiovascular event, and a 43% higher chance of a stroke.
According to National Institute of Health, there is many conditions link to psoriasis. These include:
- Depression
- Other autoimmune conditions such as Crohn’s, celiac.
- Type 2 diabetes
- High blood pressure
- Liver disease
- Hardening of the arteries
- Kidney disease
- Metabolic syndrome
- Eye infections
- Parkinson’s disease
- Osteoporosis
When to Worry?
If psoriasis flares up causing discomfort, a doctor will prescribe medication to reduce the symptoms. Early treatment will help to prevent symptoms of palmoplantar psoriasis from becoming severe or disabling.
The doctor may take a small skin sample or biopsy to rule out other skin inflammatory conditions such as contact dermatitis. Commonly, the doctor can diagnose psoriasis by appearance alone.
What are the Treatment for palmoplantar psoriasis Psoriasis on the palm?
There are many ways that may lessen the symptoms of palmoplantar psoriasis. Actually, there is no cure for psoriasis or palmoplantar psoriasis; however, cases can be treated depending their symptoms and severity.
Most treatment options for palmoplantar psoriasis involve light therapy and topical or systemic medication.
A drug which works for one patient may have effects on another. Some treatment options may become less effective over time. It is important for patient to keep in contact with the doctor to find a suitable solution.
Medicated ointments and creams for palmoplantar psoriasis may include:
- Coal tar
- Salicylic acid
- Urea
- Topical corticosteroids
- Anthralin
- Vitamin D3
- Retinoids
- Tazarotene, a vitamin A derivative
- Synthetic vitamin D, such as calcipotriol (Dovonex) and calcitriol (Rocaltrol)
- Tacrolimus (Prograf) and pimecrolimus (Elidel)
Systemic treatments for psoriasis sometimes may suppress the immune system and reduce cellular turnover.
There are many common options that include:
- Otezala
- Methotrexate
- Cylcopsorine
- Acitretin
- Hydroxyurea
- Retinoids
- 6-mercaptopurine
There is a number of biologic response modifiers that seem promising for helping to control severe cases of psoriasis. These treatments require monitoring for infection, side effects, and efficacy. They include:
- IL-17 antagonists like secukinumab
- Interleukin (IL)-12/23 antagonist ustekinumab
- Anti-tumor necrosis factor alpha antagonists like infliximab, etanercept, and adalimumab
- The phosphodiesterase 4 inhibitor apremilast
- Photo therapy can be used for psoriasis treatment independently or with medication. Exposure to natural forms of narrow and broadband ultraviolet B and A light can decrease the speed of skin cell growth. Phototherapy involves routine exposure of the skin to specific doses of natural or artificial ultraviolet light.
- Patients are advised to start by spending 5-10 minutes every day in the sun. If their skin responds well, they can increase exposure time by 30 seconds daily. However, sunscreen should be applied to non-affected areas.
- Palmoplantar psoriasis symptoms can respond well to a treatment process known as PUVA which combines natural light exposure and the drug psoraen oral photosensitizing medication.
How to Prevent Palmoplantar psoriasis?
Palmoplantar psoriasis is a long-term condition. There is no cure; however, combination therapies can lessen symptoms.
- Home remedies can help to reduce pain and discomfort include lukewarm baths with mild additives like colloidal oatmeal. A person with psoriasis need to choose mild soaps and bath oils that are dye- and fragrance-free.
- After bathing, you should blot your skin dry with a soft, clean cloth to avoid irritation. You should then apply moisturizer to the damp skin. People with severe cases of psoriasis may need to re-apply the moisturizer many times throughout the day.
- Dry or cold weather increases the need for moisturizers. Oils, ointment, lotions, and creams work. Keep using moisturizers with naturally soothing, anti-inflammatory properties like aloe vera that can relieve symptoms.
- Humidifiers may decrease dry skin.
- When applied , capsaicin may help alleviate itching and burning.
- Anti-inflammatory and skin-healthy oral or topical supplements like barberry, tea tree oil, Epsom or Dead Sea salts, and apple cider vinegar can ease discomfort.
- Preventive measures involve avoiding triggers.
- Alcohol consumption, stress, smoking, and obesity are all considered psoriasis triggers. Alcohol can also decrease the effectiveness of treatment options.
- Any factor that places stress or alters the metabolic or immune system can trigger a flare.
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