Image type: Psoriasis
Body site: Hands and palm
Description: Psoriasis, a common skin condition, disrupts the life cycle of skin cells, causing them to rapidly accumulate on the skin’s surface. This results in the formation of thick, silvery scales and itchy, dry, red patches that can sometimes be painful. Psoriasis is a persistent, long-lasting (chronic) disease that may fluctuate in severity over time.
Most types of psoriasis undergo cycles, flaring up for a few weeks or months before subsiding or even going into complete remission. Psoriasis affecting the palms and soles often presents as partially or completely red, dry, and thickened skin, sometimes with deep painful cracks (fissures). These skin changes typically have a sharp border and are often symmetrical, with similar distribution on both palms and/or both soles. However, distinguishing palmar psoriasis from hand dermatitis or other forms of acquired keratoderma can sometimes be challenging. Additionally, plantar psoriasis may resemble tinea pedis in appearance, further complicating diagnosis.
Causes: The tendency to develop psoriasis is inherited, but the specific factors that cause it to localize on the palms and soles remain unknown. It may be triggered by skin injuries, infections, or other skin conditions such as hand dermatitis, and it may first occur during periods of psychosocial stress. Certain medications, particularly lithium, may exacerbate psoriasis flares.
Diagnosis: Psoriasis signs and symptoms can vary among individuals and may include red patches of skin covered with silvery scales, small scaling spots, dry, cracked skin, itching, burning, or soreness, thickened, pitted, or ridged nails, and swollen and stiff joints. Psoriasis patches can vary in size and severity, ranging from minor scaling to extensive eruptions covering large areas of the body.
Diagnosing palmoplantar psoriasis involves identifying red, dry, thickened skin with sharp borders, often accompanied by painful cracks, which may resemble other dermatological conditions like hand dermatitis or fungal infections. Diagnosis is primarily clinical, supported by the presence of plaque psoriasis in other areas, with rare cases requiring skin biopsy or mycology tests to rule out infections.
Treatment: The primary goal of treatment is to slow down the rapid growth of skin cells, offering significant relief to affected individuals. While a cure for psoriasis remains elusive, various treatments, including lifestyle measures such as using nonprescription cortisone cream and controlled exposure to natural sunlight, may help alleviate symptoms. Additionally, identifying and addressing triggers such as skin injuries, infections, stress, and certain medications like lithium is crucial. Patients with comorbidities like obesity, metabolic syndrome, excessive alcohol consumption, or tobacco use may experience more severe and challenging-to-treat psoriasis, necessitating comprehensive management strategies tailored to individual needs.