What are the different types of palmoplantar dermatoses?

Comprehensive List of Palmoplantar Dermatoses

Palmoplantar dermatoses encompass a diverse group of skin conditions affecting the palms and soles, including inflammatory, infectious, genetic, and neoplastic disorders that can significantly impact quality of life and require specific management approaches.

Classification of Palmoplantar Dermatoses

1. Inflammatory Dermatoses

• Psoriasis

  • Palmoplantar psoriasis (affects 20.7% of palmoplantar cases) 1
  • Characterized by well-demarcated erythematous plaques with silvery scales
  • Often requires systemic therapy when topical treatments fail 2

• Eczematous Conditions

  • Hand and foot eczema
  • Contact dermatitis (allergic and irritant)
  • Dyshidrotic eczema (pompholyx)
  • Hyperkeratotic hand dermatitis 3
  • Juvenile plantar dermatosis 4

• Lichen Planus

  • Characterized by violaceous, flat-topped papules 5

2. Infectious Dermatoses

• Fungal Infections

  • Tinea pedis/manuum
  • Moniliasis (candidiasis) - 19% of palmoplantar cases 1
  • Diagnosis confirmed by KOH preparation or culture

• Bacterial Infections

  • Pitted keratolysis (6% of cases) 1
  • Erythrasma

• Viral Infections

  • Warts (verruca vulgaris, verruca plantaris)
  • Hand-foot-mouth disease

• Other Infections

  • Scabies
  • Syphilis (secondary)
  • Tuberculosis 5

3. Keratodermas

• Acquired Palmoplantar Keratoderma

  • Keratoderma climactericum
  • Drug-induced
  • Malnutrition-associated
  • Chemically induced (arsenic, polycyclic aromatic hydrocarbons)
  • Systemic disease-related
  • Malignancy-associated
  • Dermatoses-related
  • Infectious
  • Idiopathic 6

• Hereditary Palmoplantar Keratoderma

  • Diffuse, focal, or punctate forms
  • With or without epidermolysis
  • Can be isolated or part of syndromes 5

4. Hyperhydrosis-Related Conditions

• Palmoplantar hyperhidrosis (7% of cases) 1
• Keratolysis exfoliativa (6% of cases) 1

5. Reactive Conditions

• Palmar erythema

  • Associated with liver disease, pregnancy, rheumatoid arthritis, thyroid disorders
  • Can be medication or chemotherapy-induced 7

• Palmar-plantar erythrodysesthesia syndrome (PPES)

  • Associated with chemotherapy agents (5-fluorouracil, capecitabine, doxorubicin) 7

6. Other Dermatoses

• Calluses and corns
  • Hyperkeratosis due to pressure or friction 2
• Pustular disorders
  • Pustular psoriasis
  • Acrodermatitis continua of Hallopeau
• Vesiculobullous disorders
  • Epidermolysis bullosa
  • Bullous pemphigoid

Diagnostic Approach

• Detailed history including occupation, medications, and family history
• Physical examination of lesion morphology and distribution
• KOH preparation for scaly lesions
• Gram staining for pustular lesions
• Patch testing for suspected contact dermatitis
• Skin biopsy when diagnosis is uncertain 1

Treatment Considerations

• For inflammatory conditions:

  • Topical corticosteroids, calcineurin inhibitors
  • Phototherapy (PUVA, NB-UVB)
  • Systemic agents for severe cases (methotrexate, cyclosporine, biologics) 2

• For infectious causes:

  • Appropriate antimicrobial therapy based on pathogen

• For keratodermas:

  • Keratolytics (urea, salicylic acid, lactic acid)
  • Physical debridement
  • Topical retinoids
  • Systemic retinoids for severe cases 6

• For hyperkeratosis:

  • Regular assessment using validated tools
  • Pressure redistribution and cushioning
  • Careful debridement by a podiatrist experienced with EB 2

Palmoplantar dermatoses frequently involve both palms and soles (44.3%), with some conditions preferentially affecting only palms (28%) or only soles (27.3%) 1. Proper diagnosis is essential for effective management, as these conditions significantly impact quality of life and may be associated with systemic diseases.