From the Guidelines
Treatment for palmar-plantar psoriasis should start with topical maxacalcitol ointment, as recommended by the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures 1.
First-Line Treatment
- Topical maxacalcitol ointment can be considered as an initial treatment for palmoplantar psoriasis, including palmoplantar pustulosis.
- Potent topical corticosteroids like clobetasol propionate 0.05% ointment applied twice daily for 2-4 weeks, often under occlusion at night to enhance penetration, can also be used.
Maintenance Therapy
- For maintenance, transition to a moderate-strength steroid like mometasone furoate 0.1% used 2-3 times weekly.
- Vitamin D analogs such as calcipotriol can be combined with steroids, either as separate applications or in combination products like Dovobet/Enstilar.
Second-Line Treatment
- If topicals fail, second-line options include phototherapy (PUVA or narrowband UVB), oral retinoids (acitretin 10-25mg daily), or methotrexate (7.5-20mg weekly).
- Biologics like adalimumab, secukinumab, or guselkumab may be necessary for severe or resistant cases.
Additional Considerations
- Palmar-plantar psoriasis is particularly challenging to treat due to the thick stratum corneum limiting medication penetration and the functional impact on daily activities, often requiring more aggressive or combination approaches than psoriasis in other locations.
- Ustekinumab can be used as monotherapy for adult patients with moderate-to-severe plaque psoriasis affecting the palms and soles (plaque type palmoplantar psoriasis) 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Palmar-Plantar Psoriasis
- Topical therapies, such as corticosteroids and vitamin D analogs, are commonly used to treat palmar-plantar psoriasis 2, 3.
- Combination therapies, including the use of topical agents with biologics, conventional systemic agents, and phototherapy, may provide additional clinical benefits 4.
- Classical management of mild to moderate palmar-plantar psoriasis relies on the use of potent topical corticosteroids, phototherapy, and/or acitretin 2.
- Biologic therapy, including anti-interleukin-17 agents and phosphodiesterase type 4 inhibitors, has shown promising results in the treatment of palmar-plantar psoriasis 2.
Topical Therapies for Palmar-Plantar Psoriasis
- Topical vitamin D analogs, such as calcipotriene, have been shown to be effective in the treatment of psoriasis, either as monotherapy or in combination with topical steroids 3.
- Topical corticosteroids, such as clobetasol propionate, are commonly used to treat psoriasis, and their potency and formulation can influence their effectiveness 5.
- The use of penetration enhancers, such as propylene glycol, can increase the potency of topical corticosteroids, but new formulations with reduced concentrations of these additives may be equally effective 5.
Patient Adherence and Treatment Outcomes
- Patient adherence to topical treatment can be a major difficulty, and keeping the treatment regimen simple and using new and sophisticated treatment vehicles can improve treatment outcomes 6.
- Addressing patient preferences and concerns about treatment-related toxicities, and managing their expectations, are important aspects of patient care 6.