Diagnosis: Localized Pustular Psoriasis of the Palms and Soles
Pustular psoriasis is a subtype of psoriasis that can be extremely debilitating and, when generalized, life-threatening. The form that is generalized is known as acute von Zumbusch pustular psoriasis. This case represents the localized form, also known as localized palmoplantar pustular psoriasis. Although the surface area of the hands and feet can account for far less than 10 percent of the total body surface area (which means many insurance programs will not cover the cost of some of the needed biologic agents), the palmar/plantar involvement can profoundly affect quality of life. There are reports of infections preceding the occurrence of the localized forms. Pustular psoriasis is often extremely resistant to therapy and may need a combination of treatments, including biologic agents, to achieve satisfactory control. Underlying bone changes and psoriatic arthritis are associated with this condition. Acrodermatitis continua of hallopeau is the term given to the chronic, treatment-resistant form of localized palmoplantar pustular psoriasis.
In this particular case, the patient was started on a combination therapy program utilizing CutiCort spray, narrow-band UVB phototherapy, cyclosporine (Neoral) and etanercept (Enbrel). The “after” photograph was taken 28 days following the initiation of therapy. She was very happy with the treatment results and returned to her normal life (no more wheelchair). She was seen at follow-up over the next nine months with only minor involvement/flare-ups, her condition under excellent control.
For more information, contact Charles E. Crutchfield III, MD at Crutchfield Dermatology or visit www.CrutchfieldDermatology.com.