Palmoplantar psoriasis: A phenotypical and clinical review with introduction of a new quality-of-life assessment tool

Background: Palmoplantar psoriasis is associated with significant quality-of-life issues. Its epidemiology and phenotypical expression remain ill defined. Objective: We reviewed the literature and our clinical experience and developed a new quality-of-life assessment tool. Methods: We conducted a retrospective review of 150 patients with palmoplantar psoriasis. Results: In all, 78 (52%) patients displayed predominantly hyperkeratotic palmoplantar lesions, 24 (16%) pustular, 18 (12%) combination, and 30 (20%) had an indeterminate phenotype. In 27 (18%) patients, lesions were confined to the palms and soles. A new quality-of-life index was constructed to characterize disease severity. In all, 27 (18%) had mild, 72 (48%) moderate, and 51 (34%) severe disease involvement. Palmoplantar disease severity appeared independent from the degree of body surface area involvement. Limitations: This was a retrospective review. The quality-of-life index remains to be statistically verified in prospective clinical studies. Conclusion: Defining morphologic subtypes together with the use of a specific quality-of-life assessment tool in patients with palmoplantar psoriasis will improve our understanding and treatment of this recalcitrant form of psoriasis. (J Am Acad Dermatol 2009;60:1024-31.)