Palmoplantar Psoriasis: Causes, Symptoms, and Treatment

Date: Dec-17-2016 Psoriasis is a noncontagious, autoimmune condition that affects the skin and the joints. It can appear almost anywhere on the body, but it most frequently affects the arms, legs, scalp, lower back, and upper torso. Palmoplantar psoriasis usually affects the palms of the hands and the soles of the feet specifically.

The Centers for Disease Control and Prevention (CDC) estimate that 3.1 percent of American adults aged 20 to 59 have some form of psoriasis.
The World Health Organization (WHO) reported that the prevalence of psoriasis has reached 11.4 percent in some countries. The WHO term psoriasis a "serious global threat."

Contents of this article:

Who is affected by psoriasis?

Causes of psoriasis

Symptoms of palmoplantar psoriasis

Treatment for palmoplantar psoriasis

Prevention and outlook

Who is affected by psoriasis?

Psoriasis is a common autoimmune condition with varying symptoms and severity.

The symptoms and severity of psoriasis vary. In severe psoriasis, scaly patches or plaques on the skin can affect most of the body and can be extremely painful. A severe case of psoriasis can be disabling and cause social stress. However, some people have few noticeable symptoms.

According to the American Academy of Dermatology, 20 percent of psoriasis cases in the United States are moderate to severe, involving at least 5 percent of the skin.

A form of inflammatory arthritis, psoriatic arthritis, develops alongside skin plaques in at least 10 to 20 percent of cases.

A person will usually develop their first flare of psoriasis between the ages of 15 and 35 years, but it may develop at any age. Caucasians over the age of 50 appear to have the highest chance of developing psoriasis.

People with metabolic disorder, a condition characterized by obesity, diabetes, and high blood pressure, may also develop psoriasis

Causes of psoriasis

The exact causes of psoriasis remain unclear, but research suggests that genetics play a role.

However, while around 10 percent of Americans inherit at least one psoriasis- linked gene, only around 3 percent develop the condition. This suggests that factors other than genetics may have an impact.

Palmoplantar psoriasis appears to be one of the more common forms of the condition. One study suggests that it accounts for 14 percent of all psoriasis cases.

People with palmoplantar psoriasis usually develop symptoms on the palms of their hands and the soles of their feet. Hands and feet tend to be more exposed to environmental and chemical triggers, and this may play a role in the development and progression of the condition.

One study found that industrial workers had a higher chance of developing palmoplantar psoriasis, possibly due to exposure to chemicals, irritants, injury, and infection.

Symptoms of palmoplantar psoriasis

There are five major types of psoriasis but plaque-type psoriasis accounts for 90 percent of all cases.

People with plaque psoriasis typically develop well-defined areas of raised, red, scaly patches of thickened skin with a silvery tinge. Plaques can feel painful, itchy, and sometimes feel as if they are burning. Some may crack and bleed.

Palmoplantar psoriasis can occur 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 may appear as typical psoriasis plaques or as more unified, less obviously inflamed thickenings of the skin called acquired keratodermas.

Palmoplantar psoriasis can make it difficult to carry out everyday activities such as walking.

The location of symptoms also makes it harder to keep the lesions clean and to hide them. This can lead to embarrassment and social anxiety.

At least three separate disorders are related to palmoplantar psoriasis:

Palmoplantar pustulosis

Palmoplantar pustular psoriasis

Acral pustulosis

Each of these conditions involves clusters of white pustules alongside normal psoriasis plaques. In arcal pustulosis, these pustules extend to the tips of the fingers or toes.

Risk factors and triggers

Stress may be a trigger for palmoplantar psoriasis.

Environmental risk factors and lifestyle choices may increase the likelihood of developing palmoplantar psoriasis.

These include:

Stress

Injury or wounds

Severe sunburn

Bug bites

Chemical and physical irritants

Allergens

Skin infections

Common bacterial infections such as pneumonia or strep throat

Viral infections such as HIV

Inflammatory conditions such as bronchitis, tonsillitis

Autoimmune conditions

Heavy alcohol consumption

Smoking

Cold weather or abrupt changes in weather

Obesity

Medications and other conditions that may trigger psoriasis include:

Antimalarials

Lithium

Indomethacin and other inflammatory medications

High blood pressure and general heart medications

Sudden withdrawal from oral corticosteroids or systemic steroids

Salicylates, iodine, trazodone, penicillin, hydroxychloroquine, calcipotriol

Calcium deficiency

Complications

People with psoriasis may develop other serious medical conditions. Those with severe psoriasis may have a 58 percent higher chance of a major cardiovascular event, and a 43 percent higher chance of a stroke.

The National Institute of Health link a number of medical conditions to psoriasis.

These include:

Other autoimmune conditions such as Crohn's, celiac, or inflammatory bowel disease

Type 2 diabetes

Depression

High blood pressure

Hardening of the arteries

Liver disease

Kidney disease

Metabolic syndrome

Parkinson's disease

Eye infections

Osteoporosis

When to see a doctor

If psoriasis flares up and causes discomfort, a doctor can prescribe medication to reduce the symptoms.

Early treatment can help to prevent symptoms of palmoplantar psoriasis from becoming severe or disabling.

When diagnosing the condition, the doctor may take a small skin sample or biopsy to rule out other skin inflammatory conditions such as contact dermatitis. Often, the doctor can diagnose psoriasis by appearance alone.

Treatment for palmoplantar psoriasis

There are many therapies that may lessen the symptoms of palmoplantar psoriasis.

There is no cure for psoriasis or palmoplantar psoriasis, but cases can be treated according to their symptoms and severity.

Most treatment options for palmoplantar psoriasis involve light therapy and topical or systemic medication, either by mouth or by injection, or a combination.

A drug which works for one patient may have adverse effects on another. Some treatment options, especially topical corticosteroids, may become less effective over time. It is important for patients to keep in contact with their doctor in order to find a suitable solution.

Medicated creams and ointments for palmoplantar psoriasis include:

Salicylic acid

Coal tar

Urea

Topical corticosteroids

Anthralin

Retinoids

Vitamin D3

Synthetic vitamin D, such as calcipotriol (Dovonex) and calcitriol (Rocaltrol)

Tacrolimus (Prograf) and pimecrolimus (Elidel)

Tazarotene, a vitamin A derivative

Systemic treatments for psoriasis can suppress the immune system and reduce cellular turnover. Common options include:

Methotrexate

Cylcopsorine

Acitretin

Retinoids

Otezala

Hydroxyurea

6-mercaptopurine

A number of biologic response modifiers look promising for helping to control severe cases of psoriasis. These treatments require monitoring for infection, side effects, and efficacy.

They include:

Interleukin (IL)-12/23 antagonist ustekinumab

IL-17 antagonists like secukinumab

Anti-tumor necrosis factor alpha antagonists like infliximab, etanercept, and adalimumab

The phosphodiesterase 4 inhibitor apremilast

Photo or light therapy can be used for psoriasis treatment independently or with medication. Exposure to natural forms of narrow and broadband ultraviolet B and A light may 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 to 10 minutes each day in the sun. If the skin responds well, they can increase exposure time by 30 seconds a day. Sunscreen should be applied to nonaffected areas.

Palmoplantar psoriasis symptoms may respond well to a treatment process known as PUVA. This treatment combines natural light exposure and the drug psoraen oral photosensitizing medication.

Prevention and outlook

Palmoplantar psoriasis tends to be a long-term condition. There is no cure, but combination therapies can lessen symptoms.

Home remedies that may help to reduce pain and discomfort include lukewarm baths with mild additives like colloidal oatmeal. A person with psoriasis should choose mild soaps and bath oils that are dye- and fragrance-free.

After bathing, an individual should blot their skin dry with a soft, clean cloth to avoid irritation. They should then apply moisturizer to the damp skin. People with severe cases of psoriasis may need to reapply the moisturizer several times throughout the day.

Dry or cold weather normally increases the need for moisturizers. Oils, ointment, lotions, and creams can help. Moisturizers with naturally soothing, anti-inflammatory properties like aloe vera may relieve symptoms.

Humidifiers may also decrease dry skin.

Anti-inflammatory and skin-healthy oral or topical supplements like fish oils, barberry, tea tree oil, Epsom or Dead Sea salts, and apple cider vinegar may ease discomfort.

When applied topically, capsaicin, the spicy ingredient in chili peppers, may help alleviate itching and burning.

Preventive measures involve avoiding triggers.

Any factor that places stress or alters the metabolic or immune system may trigger a flare.

Alcohol consumption, smoking, stress, and obesity are all considered psoriasis triggers. Alcohol can also decrease the effectiveness of treatment options.

Written by Jennifer Huizen

Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.