Treatment of palmoplantar psoriasis

Palmoplantar psoriasis is difficult to treat.

Treatment principles:

Both hyperkeratosis and inflammation should be treated separately (1)

• a keratolytic agent for hyperkeratosis (1)
  
  
• calcipotriol or a moderately potent topical corticosteroid (e.g. betnovate-RD (R) ointment) may help. Topical coal tar and dithranol may also be of some benefit and some success can be achieved with photochemotherapy (8 methoxypsoralen-UVA phototherapy; PUVA) (2)
  
  
• isotretinoin has also been used to treat pustular psoriasis
  
  
• acitretin or methotrexate may be needed in disabling palmoplantar psoriasis (1)
  
  
• secukinumab, a human monoclonal antibody, has evidence of benefit in moderate to severe palmoplantar psoriasis (4)

A suggested management protocol for primary care for adults (5):

• in primary care (5):
  • stop smoking
  • dermovate ointment at night under polythene occlusion (e.g. Patches of Clingfilm (R))
  • a moisturiser of choice to be used through the day
  • early referral important for hand and foot PUVA/ Acitretin

The respective Summary of Product Characteristics must be checked before prescribing of any of the drugs mentioned above.

Reference:

• 1. The British Association of Dermatologists 2006. General management of Psoriasis -Recommendations
• 2. The British Association of Dermatologists 2006. General management of Psoriasis -Specific sites
• 3. Dermatology in Practice 2007;15(4):26-28.
• 4. Gottlieb A et al. Secukinumab shows significant efficacy in palmoplantar psoriasis: Results from GESTURE, a randomized controlled trial. J Am Acad Dermatol 2017; 76 (1).
• 5. NHS Bedfordshire Clinical Commissioning Group. Bedfordshire Psoriasis Summary Guidance - adults (Accessed 21/8/2019).