From the Guidelines
Treatment for skin cracking and peeling on palms and soles should prioritize moisturizing and topical corticosteroids, with consideration of biologic agents like adalimumab or ustekinumab for severe cases, especially those associated with psoriasis, as evidenced by recent guidelines 1.
Initial Management
- Moisturizing regularly with thick emollients like petroleum jelly, CeraVe, or Eucerin is crucial, applying them after washing hands and before bed, and wearing cotton gloves overnight to enhance absorption.
- For mild cases, over-the-counter options include 1% hydrocortisone cream applied twice daily for up to two weeks to reduce inflammation.
- Urea-containing creams (10-40%) help exfoliate and hydrate simultaneously.
Severe Cases and Psoriasis
- Prescription options for more severe cases include stronger topical corticosteroids like triamcinolone 0.1% ointment twice daily for 1-2 weeks, or tacrolimus 0.1% ointment for steroid-sparing treatment.
- For cases associated with psoriasis, especially moderate to severe plaque psoriasis affecting the palms and soles, biologic agents such as adalimumab 1 or ustekinumab 1 are recommended, given their efficacy in improving symptoms and quality of life.
- The choice between these biologics may depend on patient-specific factors, including weight, presence of psoriatic arthritis, and previous treatment responses.
Lifestyle Modifications
- Avoiding harsh soaps, using lukewarm water, wearing protective gloves with wet work, and maintaining adequate hydration are crucial lifestyle modifications.
- These measures help restore the skin barrier, reduce inflammation, and promote healing of the compromised skin.
Monitoring and Further Evaluation
- If symptoms persist beyond 2-3 weeks of treatment or if there are signs of infection (increased pain, warmth, swelling, discharge), patients should seek further medical evaluation.
- Underlying conditions like psoriasis, eczema, or fungal infections may require specific treatments, and a thorough assessment is necessary to guide appropriate management, as highlighted in guidelines for the management of psoriasis and psoriatic arthritis 1.
From the FDA Drug Label
The provided drug labels do not directly address the treatment options for outpatient management of skin cracking and peeling on the palms and soles.
The FDA drug label does not answer the question.
From the Research
Treatment Options for Outpatient Management of Skin Cracking and Peeling on the Palms and Soles
- Topical therapy is the preferred treatment modality for palmoplantar psoriasis, a condition that can cause skin cracking and peeling on the palms and soles 2.
- Clobetasol propionate 0.05% ointment is a commonly used treatment for palmoplantar psoriasis, with studies showing satisfactory improvement in 48% of patients after 6 weeks of treatment 2.
- Iontophoretic delivery of methotrexate is a promising therapeutic modality for the treatment of palmar psoriasis, with efficacy comparable to that of clobetasol propionate ointment 2.
- Clobetasol propionate emollient cream is also effective in treating patients with psoriasis or atopic dermatitis, with improved moisture content in treated skin 3.
- The use of a hydrocolloid occlusive dressing with clobetasol propionate lotion has been shown to be effective in treating chronic skin diseases, including psoriasis on the palms and soles, with complete remission achieved in 131 out of 141 patients 4.
- Different formulations of clobetasol propionate, such as spray, foam, lotion, and shampoo, may provide improved convenience and acceptance for patients, with similar efficacy and safety profiles to traditional ointment and cream formulations 5, 6.
- Treatment adherence is a crucial factor in the management of psoriasis, and the choice of vehicle may affect patient compliance, with newer formulations potentially offering better outcomes due to improved convenience and acceptance 6.