From the Guidelines
Atopic dermatitis can indeed occur on the palmar and plantar surfaces, although it is less common in these areas compared to other parts of the body. The presentation of atopic dermatitis on the palms and soles typically includes dry, thickened skin with deep painful cracks (fissures) and intense itching 1.
Clinical Presentation and Diagnosis
When diagnosing atopic dermatitis on the palms and soles, it is essential to consider alternative or concomitant causes of dermatitis, such as allergic contact dermatitis or irritant contact dermatitis, through comprehensive history taking and physical examination 1.
Treatment Approaches
Treatment for palmoplantar atopic dermatitis involves:
- Regular application of thick emollients like petroleum jelly or ceramide-containing moisturizers, particularly after handwashing or bathing while the skin is still damp
- Topical corticosteroids of medium to high potency, such as triamcinolone 0.1% or fluocinonide 0.05%, sometimes under occlusion with cotton gloves or plastic wrap to enhance penetration
- For severe cases, topical calcineurin inhibitors like tacrolimus 0.1% ointment may be used, or systemic treatments such as oral corticosteroids, cyclosporine, methotrexate, or dupilumab might be necessary 1
Challenges in Treatment
The palmar and plantar surfaces pose a particular challenge in treating atopic dermatitis due to the thicker skin and constant exposure to friction and irritants, which can exacerbate symptoms and reduce treatment effectiveness 1.
Key Considerations
Given the chronic and relapsing nature of atopic dermatitis, management should focus on controlling symptoms, preventing flares, and improving quality of life, with treatment approaches tailored to the individual patient's needs and severity of disease 1.
From the Research
Atopic Dermatitis on Palmar and Plantar Surfaces
- Atopic dermatitis (AD) is a chronic and relapsing, inflammatory skin disease characterized by impaired skin barrier function and immune system dysregulation 2.
- The disease can occur on various parts of the body, but the provided studies do not specifically mention the palmar and plantar surfaces as common areas affected by AD 3, 4, 5, 6.
- However, it is known that AD can occur on any part of the body, including the hands and feet, although this is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
Clinical Manifestations and Treatment
- AD is characterized by intense itching and recurrent eczematous lesions, and its management is demanding 2, 3, 4, 5.
- Topical corticosteroids are the first-line treatment for AD, but they can have side effects, particularly on sensitive skin areas 2, 3, 4, 5, 6.
- Topical calcineurin inhibitors, such as pimecrolimus, have similar anti-inflammatory effects to low-to-medium strength topical corticosteroids and can be used as an alternative treatment 2, 6.