Best Treatments for Palmoplantar Psoriasis

Introduction

Palmoplantar psoriasis is a chronic skin condition that affects the palms of the hands and soles of the feet, causing redness, scaling, thickened skin, and painful cracks. Due to the unique nature of these areas, treatment can be challenging. However, a combination of topical treatments, systemic medications, light therapy, and lifestyle changes can help manage symptoms effectively.

This article explores the best treatment options for palmoplantar psoriasis, including medical treatments, natural remedies, and daily management tips to help alleviate discomfort and improve skin health.

Topical Treatments

1. Coal Tar and Salicylic Acid

Coal tar and salicylic acid are two of the most widely recommended topical treatments for palmoplantar psoriasis. These ingredients help reduce scaling and inflammation by slowing excessive skin cell production.

• Coal Tar: Helps soothe inflammation and reduce itchiness.

• Salicylic Acid: Softens and removes thick, scaly skin, allowing other treatments to penetrate more effectively.

• Recommended Product: Nopsor Shampoo & Pomade, which combines these key ingredients for effective relief.

2. Corticosteroids

Corticosteroids are commonly used to reduce inflammation and redness. They are available in various strengths, with stronger formulations recommended for the thick skin of the palms and soles.

• High-potency corticosteroids (clobetasol, betamethasone): Used for severe flare-ups.

• Mild corticosteroids (hydrocortisone): Suitable for maintenance therapy to prevent long-term side effects.

• Application: Should be used under medical supervision, as long-term use can cause skin thinning.

3. Vitamin D Analogues

Vitamin D-based treatments, such as calcipotriol and calcitriol, help regulate skin cell production and reduce inflammation.

• How They Work: Slow down excessive skin cell growth.

• Best Used In Combination: Often used with corticosteroids for improved results.

4. Moisturizers & Barrier Creams

Daily moisturizing is essential for preventing dryness and cracking. Look for products with:

• Urea or lactic acid: To help exfoliate and soften thickened skin.

• Petrolatum or ceramides: To lock in moisture and protect the skin barrier.

Phototherapy (Light Therapy)

Light therapy is an effective treatment option for stubborn cases of palmoplantar psoriasis.

1. Narrowband UVB Therapy

• How It Works: Exposes affected areas to UVB light, slowing excessive skin cell growth and reducing inflammation.

• Treatment Schedule: Typically requires multiple sessions per week at a dermatologist’s office.

• Side Effects: Can cause mild redness or irritation, similar to sunburn.

2. PUVA Therapy (Psoralen + UVA)

• How It Works: Combines UVA light exposure with a photosensitizing medication (psoralen) to enhance effectiveness.

• Recommended for: Severe cases that do not respond to other treatments.

• Considerations: Requires strict adherence to treatment schedules and sun protection.

Systemic Treatments (For Severe Cases)

When topical treatments and light therapy are not enough, systemic treatments may be prescribed.

1. Biologics

Biologic medications target specific immune pathways involved in psoriasis, offering long-term relief.

• Common Biologics for Palmoplantar Psoriasis:

  • Adalimumab (Humira)

  • Secukinumab (Cosentyx)

  • Ustekinumab (Stelara)

• How They Work: Block inflammatory signals that cause psoriasis flares.

• Considerations: Require regular injections and medical supervision.

2. Oral Medications

Systemic oral treatments help control severe symptoms by suppressing the immune response.

• Methotrexate: Slows down skin cell growth and inflammation.

• Acitretin (Soriatane): A retinoid that helps reduce scaling and thickening.

• Cyclosporine: A powerful immunosuppressant for short-term flare control.

• Side Effects: May include liver toxicity, nausea, and immune suppression; require regular monitoring.

Natural Remedies & Lifestyle Adjustments

For those looking for complementary treatments, natural remedies and lifestyle changes can provide additional relief.

1. Anti-Inflammatory Diet

Certain foods can help reduce inflammation and support skin health.

• Foods to Eat: Fatty fish (omega-3s), leafy greens, berries, turmeric, nuts, and seeds.

• Foods to Avoid: Processed foods, refined sugars, dairy, and alcohol.

2. Stress Management

Stress is a known trigger for psoriasis flare-ups. Consider:

• Meditation and mindfulness techniques.

• Regular exercise (yoga, walking, swimming).

• Adequate sleep and relaxation routines.

3. Proper Skincare Routine

• Use mild, fragrance-free cleansers to avoid irritation.

• Wear protective gloves and shoes to reduce exposure to irritants.

• Avoid hot water showers which can strip the skin of essential moisture.

4. Smoking Cessation

Smoking is a well-known trigger for palmoplantar psoriasis. Quitting smoking can significantly improve symptoms and reduce flare-ups.

Conclusion

Palmoplantar psoriasis requires a comprehensive treatment approach, including topical therapies, light therapy, systemic medications, and lifestyle adjustments. The best treatment varies from person to person, and consulting a dermatologist is essential for creating an effective management plan.

By staying consistent with treatment, making necessary lifestyle changes, and following a structured skincare routine, individuals can significantly improve their symptoms and quality of life.

Further Reading:

• Palmoplantar Pustulosis vs. Palmoplantar Psoriasis
• Psoriasis Triggers: Foods You Should Avoid for Clearer Skin
• Natural Remedies for Palmoplantar Psoriasis

References

• DermNet NZ - Psoriasis of the Palms and Soles: This resource provides detailed information on the clinical presentation and treatment options for palmoplantar psoriasis, including topical treatments, phototherapy, and systemic agents.

  dermnetnz.org

   

• StatPearls - Palmoplantar Psoriasis: This article offers an in-depth overview of palmoplantar psoriasis, discussing first-line and second-line therapies, including topical corticosteroids, vitamin D analogs, phototherapy, and systemic treatments like acitretin and methotrexate.

  ncbi.nlm.nih.gov

   

• PubMed - Current Treatment and Future Prospects: This publication reviews classical management strategies for palmoplantar psoriasis, highlighting the use of potent topical corticosteroids, phototherapy, and systemic agents.

  pubmed.ncbi.nlm.nih.gov

   

• NCBI - Successful Treatment of Palmoplantar Psoriasis with Tazarotene: This study evaluates the efficacy of topical 0.1% tazarotene cream in the treatment of palmoplantar psoriasis, comparing it with clobetasol propionate.

  pmc.ncbi.nlm.nih.gov

   

• PubMed - Treatment of Severe Palmoplantar Pustular Psoriasis with Bimekizumab: This case series suggests that bimekizumab could be an effective approach for treating severe cases of palmoplantar pustular psoriasis.

  pubmed.ncbi.nlm.nih.gov