Key Insights On Treating Plantar Psoriasis

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Author(s): 
Myron A. Bodman, DPM

   New biologic therapies like etanercept (Enbrel, Amgen) and tumor necrosis factors are available for severe unresponsive psoriasis and may be tertiary care choices. Richetta and coworkers found that adalimumab (Humira, AbbVie) for 12 weeks was safe and efficacious in an open-label clinical trial of patients with palmoplantar psoriasis.7

Strategies To Avoid Exacerbating Psoriasis

It is widely accepted that psychosocial stress can trigger exacerbations of psoriasis so one should consider stress reduction exercise and behavioral counseling recommendations.8 Even in patients with mild psoriasis, there is a significant increase in the risk of myocardial infarction and stroke from this chronic inflammatory disease so internal medicine consultation is also appropriate.9,10 Patients should be aware of the recurring course of psoriasis with its periods of improvement followed by acute flares. It is also important to screen for underlying inflammatory arthritis with foot radiographs.11

   Dr. Bodman is an Associate Professor at the Kent State University College of Podiatric Medicine. He is a Diplomate of the American Board of Podiatric Medicine. Dr. Bodman is in private practice in Ohio.

References
1. Klaassen KM, Dulak MG, van de Kerkhof PC, Pasch MC. The prevalence of onychomycosis in psoriatic patients: a systematic review. J Eur Acad Dermatol Venereol. 2013 Aug 19, epub ahead of print.
2. Houghton VJ, Bower VM, Chant DC. Is an increase in skin temperature predictive of neuropathic foot ulceration in people with diabetes? A systematic review and meta-analysis. J Foot Ankle Res. 2013; 6(1):31.
3. Lallas A, Kyrgidis A, Tzellos TG, Apalla Z, Karakyriou E, Karatolias A, Lefaki I, Sotiriou E, Ioannides D, Argenziano G, Zalaudek I. Accuracy of dermoscopic criteria for the diagnosis of psoriasis, dermatitis, lichen planus and pityriasis rosea. Br J Dermatol. 2012; 166(6):1198-205.
4. Micali G, Lacarrubba F, Massimino D, Schwartz RA. Dermatoscopy: alternative uses in daily clinical practice. J Am Acad Dermatol. 2011; 64(6):1135-46.
5. Hsu SP. Formulary. In (Arndt A, Hsu J, eds.) Manual of Dermatologic Therapeutics, seventh edition, Lippincott Williams & Wilkins, Philadelphia, 2007, chapter 40, pp. 315-318.
6. 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.
7. Richetta AG, Mattozzi C, Giancristoforo S, D'Epiro S, Cantisani C, Macaluso L, Salvi M, Calvieri S. Safety and efficacy of Adalimumab in the treatment of moderate to severe palmo-plantar psoriasis: an open label study. Clin Ter. 2012; 163(2):e61-6.
8. Hunter HJ, Griffiths CE, Kleyn CE. Does psychosocial stress play a role in the exacerbation of psoriasis? Br J Dermatol. 2013; 169(5):965-74.
9. Armstrong EJ, Harskamp CT, Armstrong AW. Psoriasis and major adverse cardiovascular events: a systematic review and meta-analysis of observational studies. J Am Heart Assoc. 2013; 2(2):e000062.
10. Biyik I, Narin A, Bozok MA, Ergene O. Echocardiographic and clinical abnormalities in patients with psoriasis. J Int Med Res. 2006; 34(6):632-9.
11. Lowell DL, Osher LS, Grady AF. Incidental findings of massive heel spurs in a veteran with a variant of psoriatic arthritis. J Am Podiatr Med Assoc. 2012; 102(5):422-7.

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dinovisjpsays: December 11, 2013 at 11:33 am

One diagnosis I would add to the differential in light of the patient's contact with two family members at risk is Norwegian crusting scabies. Scabies does not spare the dorsal or volar surfaces however.

The ectoparasite can be ruled out by its absence in scrapings of the exfoliated thickened epidermis by a dermatopathologist. I will be checking out the book for purchase at the New York Conference. Thank you Drs. Bodman, Vlahovic and Schleicher.

Jim DiNovis, DPM

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