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Hyperkeratotic Eczema (Psoriasis) of the Palms

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Textbook of Hand Eczema

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Abstract

Hyperkeratotic eczema of the palms, a common yet somewhat neglected entity, is characterized by chronic, scaly, hyperkeratotic, fissure-prone, erythematous plaques on the palms and palmar surfaces of the fingers. In some patients, the eruption is itchy. This chronic, frustrating, recalcitrant disease may lead to disability in manual workers.

At times, it may be clinically or even pathologically difficult to distinguish hyperkeratotic eczema of the palms from localized plaque-type psoriasis of this area. There is some debate whether hyperkeratotic eczema of the palms is caused by a truly eczematous condition or whether it represents manifestations of psoriasis. Fortunately, for treatment purposes, distinguishing between an eczematous and a psoriasiform pathology is not essential, because the treatments used are the same for both conditions. Perhaps in part because of poor percutaneous absorption through the thick stratum corneum of the palms, hyperkeratotic eczema of the palms is difficult to control with topical therapy alone. Phototherapy or systemic therapies may be used in severe, devastating cases.

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References

  1. Diepgen TL, Andersen KE, Brandao FM, Bruze M, Bruynzeel DP, Frosch P, et al. Hand eczema classification: a cross-sectional, multicentre study of the aetiology and morphology of hand eczema. Br J Dermatol. 2009;160(2):353–8.

    Article  CAS  PubMed  Google Scholar 

  2. Hersle K, Mobacken H. Hyperkeratotic dermatitis of the palms. Br J Dermatol. 1982;107(2):195–201.

    Article  CAS  PubMed  Google Scholar 

  3. Chopra A, Maninder, Gill SS. Hyperkeratosis of palms and soles: clinical study. Indian J Dermatol Venereol Leprol. 1997;63(2):85–8.

    CAS  PubMed  Google Scholar 

  4. Pettey AA, Balkrishnan R, Rapp SR, Fleischer AB, Feldman SR. Patients with palmoplantar psoriasis have more physical disability and discomfort than patients with other forms of psoriasis: implications for clinical practice. J Am Acad Dermatol. 2003;49(2):271–5.

    Article  PubMed  Google Scholar 

  5. Veien NK, Hattel T, Laurberg G. Hand eczema: causes, course, and prognosis I. Contact Dermatitis. 2008;58(6):330–4.

    Article  PubMed  Google Scholar 

  6. Menné T, Johansen JD, Sommerlund M, Veien NK, Danish Contact Dermatitis Group. Hand eczema guidelines based on the Danish guidelines for the diagnosis and treatment of hand eczema. Contact Dermatitis. 2011;65(1):3–12.

    Article  PubMed  Google Scholar 

  7. Agner T, Andersen KE, Brandao FM, Bruynzeel DP, Bruze M, Frosch P, et al. Contact sensitisation in hand eczema patients-relation to subdiagnosis, severity and quality of life: a multi-centre study. Contact Dermatitis. 2009;61(5):291–6.

    Article  PubMed  Google Scholar 

  8. Wilkinson DS. Dermatitis from repeated trauma to the skin. Am J Ind Med. 1985;8(4–5):307–17.

    Article  CAS  PubMed  Google Scholar 

  9. Posada C, García-Doval I, de la Torre C, Cruces MJ. Value of palmar and plantar biopsies of hyperkeratotic and vesicular pustular lesions: a cross-sectional study. Actas Dermosifiliogr. 2010;101(1):103–5.

    Article  CAS  PubMed  Google Scholar 

  10. Weedon D. Skin pathology. 2nd ed. New York: Churchill Livingstone; 2002.

    Google Scholar 

  11. Aydin O, Engin B, Oğuz O, Ilvan S, Demirkesen C. Non-pustular palmoplantar psoriasis: is histologic differentiation from eczematous dermatitis possible? J Cutan Pathol. 2008;35(2):169–73.

    PubMed  Google Scholar 

  12. Akhyani M, Mansoori P, Taheri A, Asadi KZ. Acrokeratosis paraneoplastica (Bazex syndrome) associated with breast cancer. Clin Exp Dermatol. 2004;29(4):429–30.

    Article  CAS  PubMed  Google Scholar 

  13. Enta T. Dermacase. Keratoderma climactericum. Can Fam Physician. 1996;42:629–31.

    CAS  PubMed Central  PubMed  Google Scholar 

  14. Bishop PM, Barber HW. Keratoderma climactericum (Haxthausen) treated with Oestrone. Proc R Soc Med. 1937;30(6):738–40.

    PubMed Central  Google Scholar 

  15. Wachtel TJ. Plantar and palmar hyperkeratosis in young castrated women. Int J Dermatol. 1981;20(4):270–1.

    Article  CAS  PubMed  Google Scholar 

  16. Egawa K. Topical vitamin D3 derivatives in treating hyperkeratotic palmoplantar eczema: a report of five patients. J Dermatol. 2005;32(5):381–6.

    PubMed  Google Scholar 

  17. Schliemann S, Kelterer D, Bauer A, John SM, Skudlik C, Schindera I, et al. Tacrolimus ointment in the treatment of occupationally induced chronic hand dermatitis. Contact Dermatitis. 2008;58(5):299–306.

    Article  CAS  PubMed  Google Scholar 

  18. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009;60(4):643–59.

    Article  PubMed  Google Scholar 

  19. Jacobi A, Braeutigam M, Mahler V, Schultz E, Hertl M. Pimecrolimus 1% cream in the treatment of facial psoriasis: a 16-week open-label study. Dermatology. 2008;216(2):133–6.

    Article  CAS  PubMed  Google Scholar 

  20. Kumar B, Kumar R, Kaur I. Coal tar therapy in palmoplantar psoriasis: old wine in an old bottle? Int J Dermatol. 1997;36(4):309–12.

    Article  CAS  PubMed  Google Scholar 

  21. Hanifin JM, Stevens V, Sheth P, Breneman D. Novel treatment of chronic severe hand dermatitis with bexarotene gel. Br J Dermatol. 2004;150(3):545–53.

    Article  CAS  PubMed  Google Scholar 

  22. Mehta BH, Amladi ST. Evaluation of topical 0.1% tazarotene cream in the treatment of palmoplantar psoriasis: an observer-blinded randomized controlled study. Indian J Dermatol. 2011;56(1):40–3.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Adişen E, Tekin O, Gülekon A, Gürer MA. A retrospective analysis of treatment responses of palmoplantar psoriasis in 114 patients. J Eur Acad Dermatol Venereol. 2009;23(7):814–9.

    Article  PubMed  Google Scholar 

  24. Diepgen TL, Pfarr E, Zimmermann T. Efficacy and tolerability of alitretinoin for chronic hand eczema under daily practice conditions: Results of the TOCCATA open study comprising 680 patients. Acta Derm Venereol. 2012;92(3):251–5.

    Article  CAS  PubMed  Google Scholar 

  25. Schmitt-Hoffmann AH, Roos B, Sauer J, Spickermann J, Stoeckel K, Edwards D, et al. Pharmacokinetics, efficacy and safety of alitretinoin in moderate or severe chronic hand eczema. Clin Exp Dermatol. 2011;36 Suppl 2:29–34.

    Article  PubMed  Google Scholar 

  26. Ruzicka T, Lynde CW, Jemec GB, Diepgen T, Berth-Jones J, Coenraads PJ, et al. Efficacy and safety of oral alitretinoin (9-cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized, double-blind, placebo-controlled, multicentre trial. Br J Dermatol. 2008;158(4):808–17.

    Article  CAS  PubMed  Google Scholar 

  27. Thestrup-Pedersen K, Andersen KE, Menné T, Veien NK. Treatment of hyperkeratotic dermatitis of the palms (eczema keratoticum) with oral acitretin. A single-blind placebo-controlled study. Acta Derm Venereol. 2001;81(5):353–5.

    Article  CAS  PubMed  Google Scholar 

  28. Capella GL, Fracchiolla C, Frigerio E, Altomare G. A controlled study of comparative efficacy of oral retinoids and topical betamethasone/salicylic acid for chronic hyperkeratotic palmoplantar dermatitis. J Dermatolog Treat. 2004;15(2):88–93.

    Article  CAS  PubMed  Google Scholar 

  29. Rosén K, Mobacken H, Swanbeck G. Chronic eczematous dermatitis of the hands: a comparison of PUVA and UVB treatment. Acta Derm Venereol. 1987;67(1):48–54.

    PubMed  Google Scholar 

  30. Sezer E, Erbil AH, Kurumlu Z, Taştan HB, Etikan I. Comparison of the efficacy of local narrowband ultraviolet B (NB-UVB) phototherapy versus psoralen plus ultraviolet A (PUVA) paint for palmoplantar psoriasis. J Dermatol. 2007;34(7):435–40.

    Article  CAS  PubMed  Google Scholar 

  31. Simons JR, Bohnen IJ, van der Valk PG. A left-right comparison of UVB phototherapy and topical photochemotherapy in bilateral chronic hand dermatitis after 6 weeks’ treatment. Clin Exp Dermatol. 1997;22(1):7–10.

    Article  CAS  PubMed  Google Scholar 

  32. Sezer E, Etikan I. Local narrowband UVB phototherapy vs. local PUVA in the treatment of chronic hand eczema. Photodermatol Photoimmunol Photomed. 2007;23(1):10–4.

    Article  PubMed  Google Scholar 

  33. Schempp CM, Müller H, Czech W, Schöpf E, Simon JC. Treatment of chronic palmoplantar eczema with local bath-PUVA therapy. J Am Acad Dermatol. 1997;36(5 Pt 1):733–7.

    Article  CAS  PubMed  Google Scholar 

  34. Behrens S, von Kobyletzki G, Gruss C, Reuther T, Altmeyer P, Kerscher M. PUVA-bath photochemotherapy (PUVA-soak therapy) of recalcitrant dermatoses of the palms and soles. Photodermatol Photoimmunol Photomed. 1999;15(2):47–51.

    Article  CAS  PubMed  Google Scholar 

  35. Bretterklieber A, Legat FJ, Wolf P, Hofer A. Retrospective long-term follow-up in patients with chronic palmoplantar dermatoses after good response to bath PUVA therapy. J Dtsch Dermatol Ges. 2012;10(11):814–8.

    PubMed  Google Scholar 

  36. Hofer A, Fink-Puches R, Kerl H, Quehenberger F, Wolf P. Paired comparison of bathwater versus oral delivery of 8-methoxypsoralen in psoralen plus ultraviolet: a therapy for chronic palmoplantar psoriasis. Photodermatol Photoimmunol Photomed. 2006;22(1):1–5.

    Article  CAS  PubMed  Google Scholar 

  37. Nisticò SP, Saraceno R, Stefanescu S, Chimenti S. A 308-nm monochromatic excimer light in the treatment of palmoplantar psoriasis. J Eur Acad Dermatol Venereol. 2006;20(5):523–6.

    Article  PubMed  Google Scholar 

  38. Han L, Somani AK, Huang Q, Fang X, Jin Y, Xiang LH, et al. Evaluation of 308-nm monochromatic excimer light in the treatment of psoriasis vulgaris and palmoplantar psoriasis. Photodermatol Photoimmunol Photomed. 2008;24(5):231–6.

    Article  PubMed  Google Scholar 

  39. Neumann NJ, Mahnke N, Korpusik D, Stege H, Ruzicka T. Treatment of palmoplantar psoriasis with monochromatic excimer light (308-nm) versus cream PUVA. Acta Derm Venereol. 2006;86(1):22–4.

    CAS  PubMed  Google Scholar 

  40. Edwards Jr EK, Edwards Sr EK. Grenz ray therapy. Int J Dermatol. 1990;29(1):17–8.

    Article  PubMed  Google Scholar 

  41. Lindelof B, Wrangsjo K, Liden S. A double-blind study of Grenz ray therapy in chronic eczema of the hands. Br J Dermatol. 1987;117(1):77–80.

    Article  CAS  PubMed  Google Scholar 

  42. Walling HW, Swick BL, Storrs FJ, Boddicker ME. Frictional hyperkeratotic hand dermatitis responding to Grenz ray therapy. Contact Dermatitis. 2008;58(1):49–51.

    Article  PubMed  Google Scholar 

  43. Cartwright PH, Rowell NR. Comparison of Grenz rays versus placebo in the treatment of chronic hand eczema. Br J Dermatol. 1987;117(1):73–6.

    Article  CAS  PubMed  Google Scholar 

  44. Fairris GM, Jones DH, Mack DP, Rowell NR. Constitutional superficial X-ray versus Grenz ray therapy in the treatment of constitutional eczema of the hands. Br J Dermatol. 1985;112(3):339–41.

    Article  CAS  PubMed  Google Scholar 

  45. Sumila M, Notter M, Itin P, Bodis S, Gruber G. Long-term results of radiotherapy in patients with chronic palmo-plantar eczema or psoriasis. Strahlenther Onkol. 2008;184(4):218–23.

    Article  PubMed  Google Scholar 

  46. Sheehan-Dare RA, Goodfield MJ, Rowell NR. Topical psoralen photochemotherapy (PUVA) and superficial radiotherapy in the treatment of chronic hand eczema. Br J Dermatol. 1989;121(1):65–9.

    Article  CAS  PubMed  Google Scholar 

  47. Egan CA, Rallis TM, Meadows KP, Krueger GG. Low-dose oral methotrexate treatment for recalcitrant palmoplantar pompholyx. J Am Acad Dermatol. 1999;40(4):612–4.

    Article  CAS  PubMed  Google Scholar 

  48. Granlund H, Erkko P, Reitamo S. Comparison of the influence of cyclosporine and topical betamethasone-17, 21-dipropionate treatment on quality of life in chronic hand eczema. Acta Derm Venereol. 1997;77(1):54–8.

    CAS  PubMed  Google Scholar 

  49. Pickenacker A, Luger T, Schwarz T. Dyshidrotic eczema treated with mycophenolate mofetil. Arch Dermatol. 1998;134:378–9.

    Article  CAS  PubMed  Google Scholar 

  50. Lior S, Grigory K, Pnina S, Joseph S, Felix P. Therapeutic hotline. Alefacept in the treatment of hyperkeratotic palmoplantar psoriasis. Dermatol Ther. 2010;23(5):556–60.

    Article  PubMed  Google Scholar 

  51. Bulai Livideanu C, Lahfa M, Mazereeuw-Hautier J, Paul C. Efficacy of ustekinumab in palmoplantar psoriasis. Dermatology. 2010;221(4):321–3.

    Article  CAS  PubMed  Google Scholar 

  52. Bissonnette R, Poulin Y, Guenther L, Lynde CW, Bolduc C, Nigen S. Treatment of palmoplantar psoriasis with infliximab: a randomized, double-blind placebo-controlled study. J Eur Acad Dermatol Venereol. 2011;25(12):1402–8.

    Article  CAS  PubMed  Google Scholar 

  53. Katsambas A, Peris K, Vena G, Freidmann P, Wozel G, Daudén E, et al. Assessing the impact of efalizumab on nail, scalp and palmoplantar psoriasis and on quality of life: results from a multicentre, open-label, phase IIIb/IV trial. Arch Drug Info. 2009;2(4):66–70.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA

    Steven R. Feldman M.D., Ph.D. & Arash Taheri M.D.

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  1. Steven R. Feldman M.D., Ph.D.
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  2. Arash Taheri M.D.
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Correspondence to Arash Taheri M.D. .

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Editors and Affiliations

  1. Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA

    Ali Alikhan

  2. Department of Dermatology, Catholic University of Louvain, Brussels, Belgium

    Jean-Marie Lachapelle

  3. Department of Dermatology, University of California, San Francisco, California, USA

    Howard I. Maibach

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Feldman, S.R., Taheri, A. (2014). Hyperkeratotic Eczema (Psoriasis) of the Palms. In: Alikhan, A., Lachapelle, JM., Maibach, H. (eds) Textbook of Hand Eczema. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39546-8_14

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  • DOI: https://doi.org/10.1007/978-3-642-39546-8_14

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