Palmar-plantar psoriasis

Among psoriatic eruptions, differing in the place of origin, dermatologists distinguish palmar-plantar psoriasis.

With this localization of the disease, parts of the skin of the distal parts of the upper limbs (palms) and lower limbs (soles of the feet) are affected. This is where the outer horny layer of the epidermis is the thickest and contains the maximum number of layers of dead cells (corneocytes) - to enhance the barrier function of the skin and additional protection from injury and abrasion.

[1], [2]

Epidemiology

Vulgar psoriasis is the most common form of this disease, affecting 80 to 90% of patients with psoriasis. And approximately two thirds of the cases of palmar-plantar psoriasis is associated with the classic plaque psoriasis. In this case, this localization of the pathology can be the beginning of generalized psoriasis in every fourth case out of ten.

The development of pustular palmar-plantar psoriasis is more common in women aged 40 to 60 years.

[3], [4]

Causes of the palmar-plantar psoriasis

The main causes of palmar-plantar psoriasis - chronic recurrent skin pathology of autoimmune etiology - are the same as other varieties, see detailed article - Causes of psoriasis. The disease has a genetically determined nature and is transmitted through a generation, although it rarely infects children. But what leads to its localization on the palms and soles is still unknown.

[5], [6], [7]

Risk factors

The main risk factors for the development of the palmar-plantar species of psoriasis are associated with dermatologists:

• with injuries and skin infections;
• with other autoimmune diseases, such as type 2 diabetes, hyper or hypothyroidism, celiac disease (gluten intolerance);
• with stress and other conditions, destabilizing the psyche and the work of the central nervous system;
• with obesity and metabolic syndrome;
• with hypocalcemia (calcium deficiency in the body);
• with smoking (in 95% of cases) and alcohol abuse;
• with streptococcal lesions of pharyngeal and palatine tonsils;
• with the use of some medicinal preparations, in particular, lithium and its derivatives, ACE inhibitors, beta-adrenoblockers, hormones with progesterone, etc.

[8], [9], [10], [11]

Pathogenesis

The pathogenesis of keratinocytes accelerated to two or three days and their transformation into corneocytes in palmar-plantar psoriasis is also based on the characteristic disturbances of processes in the epidermis and dermis, which are a response to the cytokines of immune cells. This causes a thickening of the stratum corneum (hyperkeratosis) and the entire epidermis (acanthosis); decreases the granular epidermal layer; the expression of the ICAM1 gene, which encodes the surface glycoprotein CD54, which provides intercellular adhesion in the epidermis, is increased.

Among the histopathological signs of psoriasis, experts identify infiltration from the dermis into the epidermis of neutrophils and activated lymphocytes, as well as the presence of neutrophils in the corneal layer of the epidermis and monocytes (mononuclear leukocytes) in the papillary dermis.

[12], [13]

Symptoms of the palmar-plantar psoriasis

Clinical symptoms of palmar-plantar psoriasis depend on its variety. In dermatology, there are such kinds of psoriasis of this localization as:

• vulgar or plaque palmar-plantar psoriasis;
• pustular palmar-plantar psoriasis (chronic pustular psoriasis of Barbera or pustular palm-laryngeal psoriasis), which can be combined with plaque.

In cases of plaque psoriasis on the palms and soles of the feet, the first signs manifest themselves as clearly delineated round erythematous maculae (flat and <1 cm) or papules.

Stages

For the progressive stage of the disease, their increase in the periphery and fusion with the formation of keratin plaques (from one to several centimeters in diameter), which take the form of calluses, but only covered with sulfur or silvery-white scales (as in ordinary psoriasis) is characteristic. When desquamation of the upper layer of plaques, blood may protrude. The skin loses moisture, the rashes coarsen, leading to painful cracking.

At the stationary stage, new rashes stop, and already existing plaques turn pale and flatten, but exfoliation is greatly enhanced. Read more - Stages of psoriasis

Chronic pustular palmar-plantar psoriasis is manifested by the formation of hyperemic skin areas (as an initial sign), followed by the appearance in the upper part of spiny and granular layers of the epidermis of spongiofic (spongy) intercellular pustules of Kogoya with a diameter of up to 0.5 cm. These cavities with several "compartments ", Containing a mixture of keratinocytes and dead microphages-neutrophils (granulocyte leukocytes). Typical places for the appearance of pustules on the palms - near the base of the thumb, on the elevation in the region of the little finger, in the folds of the interphalangeal joints of the fingers; on the soles of the feet - in the zones of the arch of the foot and heel. When the pustules dry up (after about three weeks), and in their place dense dark brown crusts form which are scaly and itchy. After this, the disease passes into a state of temporary remission.

In some sources it is noted that when pustular psoriasis over the reddened areas of the skin appear towering pustules filled with pus. This is defined as palmoplacental pustulosis - a chronic inflammatory skin disease. According to some dermatologists, this may be a kind of psoriasis. But there is another point of view, confirmed by genetic studies and the establishment of a connection between palmoplacental pustules and neuroendocrine dysfunction of sweat glands on the palms and soles of the feet.

[14], [15], [16]

Complications and consequences

Consequences and complications of palmar-plantar psoriasis: soreness and difficulty in walking, difficulty in performing manual work (loss of ability to work is not excluded). The frequent complication is the attachment of infection.

Full or subtotal involvement of the skin with vulgar psoriasis can eventually lead to erythroderma, which reduces the thermoregulatory functions of the skin, and causes metabolic disorders.

[17], [18]

Diagnostics of the palmar-plantar psoriasis

Diagnosis of psoriasis of the palmar-plantar localization, as a rule, is based on the appearance of the affected. There is no need to do any special blood tests.

But - since the clinical picture of the palmar-plantar psoriasis resembles eczema and fungal diseases (fungal infections) - to establish an accurate diagnosis may require a mycological scraping from a plaque or a biopsy of the skin.

Instrumental diagnostics can include dermatoscopy, that is, examination of the skin with multiple enlargement and scanning of the rashes - with the fixation of their images, which allows an objective monitoring of the development of pathology.

[19], [20]

Differential diagnosis

Differential diagnosis should consider the likelihood of having other papulosquamous dermatological diseases in patients, including: foot demarcations, depriving (flat, pink, shingles), blennoragic keratoderma of the palms and feet, hyperkeratosis of eczema, subcorneal pustular dermatosis (Sneddon-Wilkinson syndrome), acute exanthematous pustules, herpetiform impetigo, acrodermatitis, and others.

[21], [22], [23], [24]

Treatment of the palmar-plantar psoriasis

The main local remedies for the treatment of palmar-plantar psoriasis are:

• Corticosteroid ointments, in this case, the greatest effect give ointments and creams from psoriasis, containing a powerful SCS of clobetasol propionate (Clobetasol, Dermovain, Cloveit, Psoriderm). Clobetasol can be used twice a day (and under the bandage), but no more than five consecutive days (to avoid thinning of the skin and possible systemic side effects.
• Derivatives of coal tar - ointment Antralin (Antraderm, Psoriaten, Ditranol, Zignoderm), which is used in the inpatient stage of the disease, applying to affected areas of the skin for 30-40 minutes once a day (for two months).
• Soothing, moisturizing, keratolytic external agents (urea, 2% salicylic acid, etc.). More details in the publication - Non - hormonal ointments from psoriasis

But the ointment of Psorkutan (another trade name Daivonex) based on hydroxyvitamin D3 (calcipotriol), as clinical practice shows, with psoriasis of the palms and soles is not very effective.

With a more severe form of pustular psoriasis psoriasis, physiotherapy is required in the form of PUVA therapy, as well as medicines for systemic use: retinoids Acitretin (Neotigazone), Isotretinoin (Accutane, Aknekutan, Verokutan, Roakkutan, Sotret), Etretinat (Tigazon); inhibitors of tumor necrosis factor alpha (TNF-alpha) Infliximab or Adalimumab.

Synthetic analogues of retinoic acid - preparations Izotretinoin, Etretinat and Acitretinum - contribute to the normalization of the division of skin keratinocytes. Capsules of Isotretinoin, Acitetinum or Etretinata are taken orally during meals at a daily dose of 0.1 mg per kilogram of body weight of the patient. The maximum daily dose is 25-30 mg. Treatment can last two to three months with a two-month break before the second course. Possible side effects of systemic retinoids are in reactions to increased intake of vitamin A in the body: dryness and itching of the skin, cheilitis, alopecia, deposition of calcinates in tissues, increase in blood levels of lipids.

The drug Infliximab is injected into a vein when treated in a hospital, the dose is determined individually at a rate of 3-5 mg per kilogram of body weight. This drug has a large list of undesirable side effects, including: rashes on the skin (including bullous), increasing its dryness, hyperkeratosis, hair loss; fever; dyspnea and bronchitis; nausea, diarrhea, abdominal pain; headaches, dizziness, increased fatigue; pain in the chest area, instability of blood pressure and heart rate; decreased blood clotting.

For more information, see - Treatment of psoriasis

Homeopathy - homeopathic ointment Psoril (with milk thistle seed oil and extracts of medicinal plants) and Psoriatin (based on the extract of the mahogany cadaveric cortex) can be used in the medicinal therapy of plaque psoriasis psoriasis. These funds are used twice a day.

Alternative treatment

Alternative treatment offers a variety of remedies that can help reduce the symptoms of palmar-plantar psoriasis.

It is recommended to take omega-3 fatty acids inside, for which use linseed oil (dessert spoon a day, chopped flax seed (20 mg) or fish oil (one capsule per day).

Useful baths for the feet and hands with the broths of chamomile, St. John's wort, licorice (licorice root), birch buds. And also herbal teas, which include the flowers of marigold, the leaves of a three-leafed or dandelion watch, the grass of a sweet potato - in a mixture with green tea - 100 ml three times a day.

Among the alternative recipes - infusions from the grass of the willow-tea (kapreya nizkolistnogo) - a tablespoon of dry raw materials for 200 ml of boiling water; infusion of oregano, black elderberry, tripartite, nettle, stale thistle, three-color violet, mullein scepeter-like. If you are interested in how to treat herbs, read the details in the article - Medicinal Herbs from Psoriasis

[25], [26]

Prevention

Is it possible to prevent palmar-plantar psoriasis, read - Prophylaxis of psoriasis

[27], [28], [29], [30]

Forecast

The prognosis of this disease is not very pleasant, because it is very much treatable.

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