treatment of palmoplantar psoriasis

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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:

Last edited 10/2019 and last reviewed 02/2020

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