Pustular psoriasis of the palms and soles
Pustular psoriasis can be localised (eg on the palms or soles) or generalised. See here for photos of pustular psoriasis on the hands. For information on generalised pustular psoriasis, see here.
Initial treatment for pustular palmoplantar psoriasis is a potent topical corticosteroid. Use:
1betamethasone dipropionate 0.05% ointment topically, once daily until skin is clear (usually 2 to 6 weeks) betamethasone dipropionate betamethasone dipropionate betamethasone dipropionate
OR
1mometasone furoate 0.1% ointment topically, once daily until skin is clear (usually 2 to 6 weeks). mometasone furoate mometasone furoate mometasone furoate
If response to treatment is inadequate after 3 weeks, change to a more potent topical corticosteroid. Use:
betamethasone dipropionate 0.05% ointment in optimised vehicle topically, once daily until skin is clear (usually 2 to 6 weeks). betamethasone dipropionate betamethasone dipropionate betamethasone dipropionate
Once symptoms are controlled, reduce the potency of the topical corticosteroid gradually, and withdraw if possible. If mild disease activity continues, apply the tar preparation as maintenance therapy. Use:
LPC 4 to 8%+salicylic acid 3% cream or ointment topically, twice daily1. coal tar + salicylic acid coal tar+salicylic acid coal tar+salicylic acid
LPC can be started at a lower concentration and increased according to response.
For a patient who needs a topical corticosteroid for more than 2 months, consider adding calcipotriol to the topical corticosteroid. Use:
calcipotriol+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
If the combination of calcipotriol and topical corticosteroid 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.
Reproduced with permission from the A-Z of Skin [digital]. Australasian College of Dermatologists. Sydney. https://www.dermcoll.edu.au/
Photo sourced with permission from Dr Jonathan Chan.