How To Get Rid of Psoriasis

How to Treat Psoriasis on Palm of Hand ?

What Happens if Psoriatic Arthritis is Left Untreated

Although palm and sole psoriasis affects a small (<5) percent of the total cutaneous surface, it is frequently debilitating, painful, and interferes with simple functions such as walking or buttoning one’s clothing. The impact of palm and sole psoriasis on quality of life is out of proportion to the small percent of BSA affected. Quality of life measurements demonstrate the emotional and physical impact of psoriasis limited to the palms and soles, justifying the use of systemic therapies in such patients.Thus, when intensive topical therapy under occlusion or photochemotherapy is insufficient to achieve adequate improvement and longterm control, therapy with oral or biologic medications should be given strong consideration.

Both MTX and cyclosporine are effective in a significant proportion of patients, however, the potential he- patotoxicity and bone-marrow toxicity of the former and the nephrotoxicity of the latter must be considered. Palm and sole psoriasis is often responsive to oral retinoids. Although elevations in both triglycerides and cholesterol can be a complication of retinoid therapy, these should not necessarily be a contraindication to retinoid therapy, as elevated triglycerides can be appropriately managed with fibrates, alone or combined with statins, and ele-vated cholesterol can be managed with statins. Caution needs to be exercised when statins and fibrates are given simultaneously because of the risk for rhabdomyolysis.

Other treatment options include targeted phototherapy (with 308-nm excimer laser or similar light sources) or PUVA, particularly soak PUVA in which patients soak their palms and soles for 15 to 30 minutes in a methoxsalen solution before UVA exposure. Topical PUVA usually requires treatments two or three times per week for several months for adequate clearing and mainte¬nance of control of palmoplantar psoriasis. Oral PUVA has been associated with the development of cutaneous malignancies after long-term treatment. Cutaneous malignancy on the palms or soles after topical PUVA therapy is, however, very rare. Using oral acitretin in combination with topical PUVA also reduces the number of treatments necessary for clearing and potentially decreases the risk of development of skin malignancies associated with PUVA therapy.


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