treatment of palmoplantar psoriasis
Palmoplantar psoriasis is difficult to treat.
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
- 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.
- 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).
Last edited 10/2019 and last reviewed 02/2020