Palmoplantar Psoriasis and Palmoplantar Eczema: A Comparative Review of Management and Pharmacological Therapy

Abstract

Diseases affecting the palms and soles are associated with disproportionate functional impairment and reduced quality of life due to pain, fissuring, and interference with daily activities. Among palmoplantar dermatoses, palmoplantar psoriasis and palmoplantar eczema represent two of the most common yet diagnostically challenging conditions, owing to overlapping clinical features, chronic relapsing courses, and variable therapeutic responses. Despite superficial similarities, these entities differ fundamentally in their etiology, pathophysiology, histopathology, evaluation, and management strategies.

Palmoplantar psoriasis is an immune-mediated inflammatory disorder driven predominantly by Th1 and Th17 cytokine pathways, resulting in keratinocyte hyperproliferation and marked hyperkeratosis. In contrast, palmoplantar eczema is primarily a barrier-driven disease characterized by epidermal barrier dysfunction, increased transepidermal water loss, and secondary immune activation, often within an atopic background. These pathogenic differences translate into distinct clinical presentations, histopathological findings, and therapeutic approaches.

This review provides a comprehensive comparative analysis of palmoplantar psoriasis and palmoplantar eczema, encompassing epidemiology, etiology, pathophysiology, clinical features, histopathology, evaluation, management, prognosis, and complications. Emphasis is placed on distinguishing features that aid in accurate diagnosis and on evidence-based management strategies, including the increasing role of systemic and biologic therapies in refractory palmoplantar psoriasis. A clear understanding of these differences is essential for optimal patient care, improved functional outcomes, and enhanced quality of life.