Hyperkeratotic psoriasis of the palms and soles
Psoriasis affecting the palms or soles (ie palmoplantar psoriasis) is more resistant to topical therapy because it is often hyperkeratotic. See here for a photo of hyperkeratotic psoriasis on the hands. It may mimic dermatitis, but psoriatic lesions on other parts of the body can suggest a diagnosis of psoriasis.
Treatment for hyperkeratotic palmoplantar psoriasis starts with a tar preparation, or a calcipotriol and topical corticosteroid combination. If lesions are more scaly, the tar preparation can help soften and remove the scale. Consider:
1LPC 4 to 8%+salicylic acid 6% cream or ointment topically, twice daily for 1 month1 coal tar + salicylic acid coal tar+salicylic acid coal tar+salicylic acid
OR
1calcipotriol+betamethasone dipropionate 50+500 micrograms/g ointment or foam topically, once daily until skin is clear (usually about 6 weeks). calcipotriol + betamethasone dipropionate calcipotriol+betamethasone dipropionate calcipotriol+betamethasone dipropionate
LPC can be started at a lower concentration and increased according to response. Sometimes a combination of these treatments can be considered.
If topical therapy is not effective, refer for dermatologist advice.
For practical information on using topical corticosteroids, tars and calcipotriol in psoriasis, see Topical drug treatment for psoriasis in primary care.
Photo sourced with permission from Dr Jonathan Chan.