Palmoplantar psoriasis, as its name indicates, is a form of psoriasis that affects the palms and soles, presenting as discrete, erythematous, scaling patches and plaques. These lesions are usually bilateral, and involvement of the palms typically stops at the wrist-palm junction, but the dorsal aspect of the hand can be involved. Patients often find this form of psoriasis very disabling from fissuring that makes walking painful, as well as embarrassing, due to prominent scaling on very publicly visual areas such as the hands.
In addition to the above types of psoriasis, the scalp and nails may also be affected (Fig. 9.1D, J, K). Approximately 79% of patients with psoriasis have involvement of the scalp. Nail changes can occur in up to 50 % of people with psoriasis and up to 80 % of people with psoriatic arthritis. The proximal nail fold, nail matrix, nail bed, and hyponychium can be involved with nail psoriasis. Patients may see discoloration of the nail with yellow-brown changes, pitting, nail thickening, and separation of the nail from the nail bed (onycholysis).
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