Psoriasis palmaris et plantaris (plaque type) L40.3

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 12.12.2021

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Clinical manifestation of chronic stable psoriasis with predominant or exclusive manifestation on palms and/or soles. In particular, the exclusive occurrence on palms and soles sometimes makes the clinical classification difficult.

Not infrequently, one encounters "minus variants" with localized affection of the acral finger regions (toes less affected), which are associated with unpleasant, painful and therapy-resistant rhagades for those affected, restricting daily routine tasks. The diagnosis "minus variant of psoriasis palmaris/plantaris is a purely clinical diagnosis (see Fig.).

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Clinical features
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Keratotic plaque type (most common type): Chronic inpatient, circumscribed, sharply defined, solid white or white-grey to greyish-brownish, scaly plaques of varying intensity (the scale finding depends very much on the type of pre-treatment).

With intensive local pre-treatment, sharply defined red plaques with little scaling can be found.

If these plaques persist for a longer period of time, the loss of skin elasticity causes deep, painful, occasionally bleeding rhagades in the wrinkles of the hands. This condition is extremely obstructive during daily work, especially when working in wet conditions.

The hyperkeratotic plaques are found especially in the area of the thenar and hypothenar, on the soles of the feet in the area of the pressure loaded areas.

The palmo-plantar psoriatic infestation generally closes sharply with the groin skin. This morphological peculiarity is of differential diagnostic importance in differentiating between palmo-plantar psoriatic infestation and hand dermatitis.

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Palmoplantar psoriasis, as a congenital disease, represents a particular challenge in occupational dermatological assessment. S.a. Psoriasis palmaris et plantaris, occupational dermatological relevance.

The chronic inpatient plaque type can be overlaid by dyshidrotic or even pustular attacks during episodes of relapse. If necessary, a systemic therapy must be initiated for this change of activity.

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Last updated on: 12.12.2021