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Background and Purpose:  Radiotherapy (RT) is well accepted for therapy-refractory palmo-plantar eczema or psoriasis, despite of lacking evidence regarding beneficial long term effects. Furthermore, the optimal irradiation dose is unknown. We evaluated the outcome of RT with two different RT single/total dose (SD/TD) treatment policies. Patients and Methods:  28 consecutive patients with therapy-refractory eczema (n = 22) or psoriasis (n = 6) of palms and/or soles were irradiated twice a week either with a Dmax SD of 1 Gy (6/98–5/03; median TD: 12 Gy) or 0.5 Gy (6/03–7/04; median TD: 5 Gy). Median age was 52 years (27–71), median follow-up 20 months (4–76). Totally 88 regions were treated, 49 with 1 Gy, 39 with 0.5 Gy SD. Eight different symptoms were scored from 0 (absent) –3 (severe), giving a possible sum score of 0–24. Patients' rating of RT result was also documented (worse/stable/better/complete remission). Results:  The sum score was 15 (6–23) before RT, 2 (0–16) at the end of RT, and 1 (0–21) at last follow-up, respectively. The improvement was highly significant in both treatment regimens. Better or complete remission by the patients were reported in 44 and 39 (= 83 out of 88) localisations, that was often stable during the follow-up. 5 (6%) regions in 3 (11%) patients didn't benefit from RT. Conclusion:  RT reveals excellent results in palmo-plantar eczema or psoriasis. We recommend a SD of 0.5 Gy twice a week up to a TD of 4–5 Gy. [ABSTRACT FROM AUTHOR]