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Psoriasis of the scalp, face, intertriginous areas, genitals, hands, feet, and nails is often underdiagnosed, and disease management can be challenging. Despite the small surface area commonly affected by psoriasis in these locations, patients have disproportionate levels of physical impairment and emotional distress. Limitations in current disease severity indices do not fully capture the impact of disease on a patient's quality of life, and, combined with limitations in current therapies, many patients do not receive proper or adequate care. In this review, we discuss the clinical manifestations of psoriasis in these less commonly diagnosed areas and its impact on patient quality of life. We also examine clinical studies evaluating the effectiveness of therapies on psoriasis in these regions. This article highlights the need to individualize treatment strategies for psoriasis based on the area of the body that is affected and the emerging role of biologic therapy in this regard., (© 2018 Wiley Periodicals, Inc.)

Palmoplantar psoriasis refers to a localized psoriasis variant. The disease can be associated with many clinical forms, including predominantly pustular lesions to thick scaly, hyperkeratotic plaques, or an overlapping of both of them. Palmoplantar psoriasis accounts for 3-4% of all psoriasis cases in most studies. Although it is localized only on the palms and the soles, the fissures, the hardening of the tissue, and hyperkeratosis affect daily routine activities. Taking the body surface area as a measure of severity can sometimes be misleading. In clinical practice, the level of functional impairment should be taken into account rather than relying on traditional instruments to evaluate the severity. Palmoplantar psoriasis is usually managed with topical therapy as a first step. Systemic therapy is needed when the topicals fail or when the disease becomes more severe. Sometimes, biologic agents are required for adequate maintenance of clinical response., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Necrolytic acral erythema (NAE) is a recently recognized dermatosis almost exclusively associated with hepatitis C virus (HCV) infection, and closely related to zinc deficiency. We present the case of a 60-year-old man with a history of psoriasis and chronic HCV infection, who developed new lesions of NAE extending from previous elephantine psoriatic plaques on bilateral lower legs. According to previous reports, resolution of NAE has been successfully achieved by treatment of the underlying HCV infection, or the use of oral zinc therapy. Our patient exhibited good response to zinc therapy. By reporting this case, we would like to raise the awareness of physicians to this unique acrally distributed dermatosis, which is distinct from psoriasis by its pathological feature of aggregated necrotic keratinocytes and its good response to zinc therapy rather than topical corticosteroids., (© The Author(s) 2016.)

Background: Plaque-type palmoplantar psoriasis (PPTP) is a chronic recalcitrant dermatosis with treatment modalities ranging through topical, phototherapy or systemic. Phototherapy options include various forms of ultraviolet B (UVB) and ultraviolet A with prior psoralen sensitization (PUVA). Currently, few comparative studies have been reported., Purpose: To compare Broad-Band UVB (BB-UVB) versus paint PUVA (p-PUVA) in regard to efficacy and safety in the treatment of PPTP., Methods: A retrospective non-randomized cohort study comprised of all the patients with PPTP treated in our phototherapy centre during 2010-2012, either with BB-UVB or p-PUVA., Results: Among the 248 patients included in this study, 122 received BB-UVB and 126 followed p-PUVA treatment. About 36 (30%) and 53 (42%) had complete remission, 29 (24%) and 59 (47%) responded partially and 57 (47%) and 14 (11%) patients did not improve with BB-UVB and p-PUVA, respectively. The odds ratio for remission (p-PUVA: BB-UVB) was 7.9. Duration of remission was 21.9 ± 1.34 months for p-PUVA and 16.75 ± 1.83 months for BB-UVB., Conclusion: Both BB-UVB and p-PUVA are good therapeutic options for PPTP. P-PUVA emerges as the superior treatment modality, yielding a better and more extended response. BB-UVB represents a feasible alternative in patients with milder disease or possible contraindications for p-PUVA.

Nail disorders are difficult to treat and often frustrating both for patients and clinicians. Because of the slow growth rate of the nail plate and the difficulty of getting the drug actives to penetrate the nail tissues, it is usually necessary to wait several months before seeing the results of treatments. This delay often leads to discontinuation of therapy by the patients. This article therefore helps clinicians to find the right treatment of the 5 most common nail disorders (brittle nails, onycholysis, paronychia, psoriasis, and onychomycosis) and provides practical tips that might improve patients' compliance., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Rubbing the skin and trauma may influence the persistence of psoriasis over time., Objectives: To assess the impact of a new fabric made with a special fluorine-synthetic fiber in improving plantar psoriasis., Methods: A total of 20 patients with symmetrical lesions were randomized to receive on one side a sock made of fluorine-synthetic fiber and on the other side a sock made of cotton fabric for 4 weeks. The main outcome was the percentage reduction of lesional area., Results: In an intention-to-treat analysis, the median lesion reduction was 11.95% in fluorine-synthetic fiber arm and 11.89% in cotton arm (p = 0.776). Among secondary outcomes, patient global satisfaction showed a statistically significant median score of 32 toward fluorine-synthetic fiber arm (p = 0.011)., Conclusion: In spite of our main negative results, it is important to continue investigating on the relation between textiles and skin disorders to improve patient well-being.

Background/aims: Rubbing the skin may influence the persistence of pustulosis over time. The aim of this study was to assess the impact of a new fabric made with fluorine-synthetic fiber in improving plantar pustulosis., Methods: A total of 17 patients were randomized to receive on one side a sock made of fluorine-synthetic fiber and on the other a sock made of cotton fabric for 4 weeks. The main outcome was the percentage reduction of lesional area at week 4., Results: The median lesion reduction at week 4 was 42.6% in the fluorine-synthetic fiber arm and 2.7% in the cotton arm (p = 0.148). Among secondary outcomes, the overall reduction over time in the treated areas was significantly in favor of the fluorine-synthetic fiber arm (p = 0.045) as well as the perception of the disease by the patient (p = 0.025)., Conclusion: Despite the fact that the primary outcome was not reached, there was a tangible reduction in the extension of the treated areas and in the perception of the disease by the patient., (© 2014 S. Karger AG, Basel.)

Palmoplantar pustulosis (PPP) is difficult to treat. There is little hard evidence for the efficacy of any treatment and no published guidelines for its management. A number of exacerbating factors are well documented and there is some evidence for the importance of others. Smoking is the most recognized environmental trigger and recent research has concentrated on the role of eccrine sweat glands in this regard. Other factors, including tonsillar streptococcal infection and gluten sensitivity, may be important in selected cases. The aim of this review is to challenge dermatologists to consider alternative management strategies for PPP and design clinical trials that will enable the development of useful therapeutic guidelines., (© 2011 The Authors. BJD © 2011 British Association of Dermatologists.)

Background: Topical therapy is generally insufficient in palmoplantar psoriasis. UVBTL01 phototherapy is a therapeutic alternative and we conducted a retrospective study of the efficacy and safety of this approach and of PUVA therapy in palmoplantar psoriasis., Patients and Methods: All patients treated with UVBTL01 or PUVA therapy from November 2001 to April 2008 were included in the study. Phototherapy was given three times a week. Evaluation was performed after 20 sessions, again after 30 sessions and then at the end of the treatment. Therapeutic outcome was classed as "failure", "slight improvement" or "improvement or clear skin"., Results: UVBTL01 phototherapy and PUVA therapy were effective, with "improvement or clear skin" in respectively 52% and 61% of cases and "slight improvement" in 16% and 23% of cases at the end of the treatment. With UVBTL01, adverse effects occurred in 20% of cases (erythema 18%, first-degree burns 7%) and treatment was discontinued as a result in only 4% of cases. Adverse effects occurred in 50% in patients on PUVA therapy, mainly due to methoxypsoralen intake., Conclusion: UVBTL01 phototherapy and PUVA therapy are efficacious treatments in palmoplantar psoriasis; UVBTL01 phototherapy involves fewer constraints and has fewer adverse effects., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Hand and foot psoriasis impairs patients' ability to function, impacts them financially, and chips away at their self-worth. Dermatology nurses play an important role with these patients in improving their quality of life through support, counsel, education, and meeting their medical and emotional needs.

Palmoplantar psoriasis is an idiopathic disabling condition, often resistant to conventional therapies. The purpose of this study was to evaluate the efficacy and safety of local narrowband ultraviolet B (NB-UVB) phototherapy and to compare it with local psoralen plus ultraviolet A (PUVA) paint in patients with palmoplantar psoriasis unresponsive to conventional therapies other than phototherapy. A cohort of 25 patients with palmoplantar psoriasis were included in this study, which was based on a left-to-right comparison pattern. The treatments were administered with local narrowband UVB irradiation on one side and local PUVA on the other side three times a week over 9 weeks. Clinical assessments were performed at baseline and every 3 weeks during the 9-week treatment. There was a statistically significant decrease in the mean clinical scores at the third, sixth and ninth week with both treatments. The difference in clinical response between the two treatment modalities was statistically significant at the end of the treatment period, with the percentage reduction in severity index scores with the PUVA-paint-treated side being 85.45% compared with 61.08% for the NB-UVB treated side (t = 5.379, P = 0.0001, Student's t-test for unpaired samples). Our results show that, although some clinical improvement was achieved with local NB-UVB phototherapy, the results were better with local PUVA, and such a treatment option may be reserved for patients with palmoplantar psoriasis who experience phototoxic reaction to psoralens.

FROM A CLINICAL POINT OF VIEW: Infantile acropustulosis is a rare and little known dermatosis affecting young children. Clinically, it consists of prurigenous vesiculo-pustular lesions characteristically localised on the palms of the hands and the soles of the feet. NO CONFUSION SHOULD EXIST: The principle differential diagnosis is scabies. The other differential diagnosis is neonatal pustulosis. A CONTROVERSIAL HYPOTHESIS: The aetiopathogenesis is unknown, but some cases of infantile acropustulosis set-in in the course of a genuine scabies, which might suggest a hypersensitivity reaction to Sarcoptes scabiei. It is a benign affection, progressing in flares, occasionally provoking severe pruritus. Treatments are disappointing, and the disease heals spontaneously after a few years.