From the Guidelines
The optimal treatment for a patient with concurrent palmoplantar psoriasis and tinea pedis is to start with a topical antifungal such as terbinafine 1% cream applied twice daily for 2-4 weeks, or ciclopirox 0.77% cream twice daily for 4 weeks, alongside high-potency topical corticosteroids like clobetasol propionate 0.05% ointment applied twice daily for 2 weeks, then taper to once daily or less frequent application, and consider adding acitretin (10-25mg daily) for moderate-to-severe cases. For the tinea pedis, oral terbinafine 250mg daily for 2 weeks or fluconazole 150mg weekly for 2-4 weeks may be necessary in severe or resistant cases 1. For the palmoplantar psoriasis, combining high-potency topical corticosteroids with a vitamin D analog such as calcipotriene 0.005% ointment can improve efficacy, and for maintenance, consider calcineurin inhibitors like tacrolimus 0.1% ointment 1. It's crucial to treat the fungal infection first or simultaneously, as corticosteroids can worsen tinea infections if used alone. Proper foot hygiene is essential, including keeping feet dry, wearing breathable footwear, and using antifungal powders preventatively. Regular follow-up is important to monitor treatment response and adjust therapy as needed, considering the potential side effects of acitretin, such as benign intracranial hypertension, blurred or decreased night vision, and increased incidence of vulvovaginitis due to Candida albicans 1. In moderate-to-severe cases, systemic therapies may be required, including methotrexate (7.5-25mg weekly), or biologics, and acitretin has been shown to be effective in treating severe psoriasis variants, such as erythrodermic psoriasis, generalized pustular psoriasis, and palmoplantar psoriasis 1. The dosage of acitretin should be balanced with the individual patient’s tolerability, with doses ranging from 10 to 50 mg daily, and the major element in dosing acitretin is balancing efficacy with the individual patient’s tolerability 1.
From the Research
Treatment Options for Palmoplantar Psoriasis and Tinea Pedis
- The optimal treatment for a patient with concurrent palmoplantar psoriasis and tinea pedis is not directly addressed in the provided studies, but some studies suggest treatment options for each condition separately.
- For palmoplantar psoriasis, topical treatments such as tazarotene cream 2 and calcipotriol-clobetasol propionate combination 3 have been shown to be effective.
- Excimer lamp therapy has also been found to be effective in treating palmoplantar psoriasis, with similar efficacy to calcipotriol-clobetasol propionate combination 3.
- For tinea pedis, the provided studies do not offer specific treatment options, but it is generally treated with antifungal medications.
Considerations for Concurrent Treatment
- When treating a patient with concurrent palmoplantar psoriasis and tinea pedis, it is essential to consider the potential interactions between treatments for each condition.
- Topical corticosteroids, such as clobetasol propionate, are commonly used to treat palmoplantar psoriasis, but their use may need to be carefully considered in patients with tinea pedis due to the potential for worsening fungal infections 4.
- The use of antifungal medications to treat tinea pedis may also need to be considered in conjunction with treatments for palmoplantar psoriasis.
Expert Recommendations
- A narrative review on therapeutic options for palmoplantar pustulosis suggests that topical corticosteroids are a first-line therapy, and oral acitretin is recommended for systemic treatment 5.
- However, these recommendations may not be directly applicable to patients with concurrent palmoplantar psoriasis and tinea pedis, and treatment should be individualized based on the specific needs of the patient.