Evidence and Suggested Therapeutic Approach in Psoriasis of Difficult-to-treat Areas: Palmoplantar Psoriasis, Nail Psoriasis, Scalp Psoriasis, and Intertriginous Psoriasis

Overview

Journal Indian J Dermatol

Specialty Dermatology

Date 2017 Apr 13

PMID 28400628

Citations 21

Authors

Nilendu Sarma

Affiliations

Soon will be listed here.

Abstract

Psoriasis is resistant to treatment and it shows frequent relapse; systemic treatment is often associated with toxicities, and long-term safety data are lacking for most of the newer drugs like biologics. Moreover, some body areas such as hands, feet, intertriginous areas, scalp, and nails are even more resistant. Frequently, systemic treatments are necessary considering the higher psychological impact on the patient. There is a lack of agreement on the best therapeutic modalities in the management of psoriasis involving difficult-to-treat locations. At present, there are no Indian guidelines for these conditions. Available literature has been reviewed extensively on the treatment of psoriasis involving difficult-to-treat locations; level of evidence has been evaluated as per the Oxford Centre for Evidence-Based Medicine 2011 guideline, and therapeutic suggestions have been developed. Best care has been employed to consider socioeconomic, cultural, genetic, and ethnic factors to prepare a therapeutic suggestion that is appropriate and logical to be used among Indian population and people of similar ethnic and socioeconomic background.

Citing Articles

Updates on Psoriasis in Special Areas.

Butacu A, Toma C, Negulet I, Manole I, Banica A, Plesea A J Clin Med. 2025; 13(24.

PMID: 39768472 PMC: 11728371. DOI: 10.3390/jcm13247549.

Fractional Carbon Dioxide Laser Combined with Secukinumab in the Treatment of Refractory Psoriasis Lesions on the Lower Legs.

Ye H, Li W, Gan Y, Zhu E, Zheng H, Luo Q Clin Cosmet Investig Dermatol. 2024; 17:2953-2959.

PMID: 39717834 PMC: 11664094. DOI: 10.2147/CCID.S493967.

Efficacy of Ixekizumab in Chinese Patients with Moderate-to-Severe Psoriasis and Special Body Area Involvement: Sub-analysis of a Randomized, Double-Blind, Multicenter Phase 3 Study.

Li X, Ding Y, Zhang C, Lu Y, Li F, Pan W Adv Ther. 2024; 42(1):146-163.

PMID: 39347926 DOI: 10.1007/s12325-024-02976-w.

Effectiveness of Ixekizumab in Chinese Patients with Moderate-Severe Plaque Psoriasis with Special Area Involvement: Subanalysis of a Prospective, Multicenter, Observational Real-World Study.

Li Y, Lv C, Dang L, Lin B, Tao J, Zhang C Dermatol Ther (Heidelb). 2024; 14(4):907-918.

PMID: 38536616 PMC: 11052755. DOI: 10.1007/s13555-024-01134-y.

New-Onset and Exacerbation of Psoriasis following COVID-19 Vaccination: A Systematic Review of Case Reports and Case Series.

Arifin A, Hengky A, Widjaja M, Wijaya L Indian J Dermatol. 2024; 68(6):724.

PMID: 38371588 PMC: 10868966. DOI: 10.4103/ijd.ijd_833_22.

References

Kreuter A, Sommer A, Hyun J, Brautigam M, Brockmeyer N, Altmeyer P . 1% pimecrolimus, 0.005% calcipotriol, and 0.1% betamethasone in the treatment of intertriginous psoriasis: a double-blind, randomized controlled study. Arch Dermatol. 2006; 142(9):1138-43. DOI: 10.1001/archderm.142.9.1138. View

Martin Ezquerra G, Regana M, Herrera Acosta E, Millet P . Topical tacrolimus for the treatment of psoriasis on the face, genitalia, intertriginous areas and corporal plaques. J Drugs Dermatol. 2006; 5(4):334-6. View

Chen X, Yang M, Cheng Y, Liu G, Zhang M . Narrow-band ultraviolet B phototherapy versus broad-band ultraviolet B or psoralen-ultraviolet A photochemotherapy for psoriasis. Cochrane Database Syst Rev. 2013; (10):CD009481. PMC: 11076274. DOI: 10.1002/14651858.CD009481.pub2. View

Nakamura R, de Abreu L, Duque-Estrada B, Tamler C, Leverone A . Comparison of nail lacquer clobetasol efficacy at 0.05%, 1% and 8% in nail psoriasis treatment: prospective, controlled and randomized pilot study. An Bras Dermatol. 2012; 87(2):203-11. DOI: 10.1590/s0365-05962012000200003. View

Moore A, Gordon K, Kang S, Gottlieb A, Freundlich B, Xia H . A randomized, open-label trial of continuous versus interrupted etanercept therapy in the treatment of psoriasis. J Am Acad Dermatol. 2006; 56(4):598-603. DOI: 10.1016/j.jaad.2006.09.002. View

Poulin Y, Crowley J, Langley R, Unnebrink K, Goldblum O, Valdecantos W . Efficacy of adalimumab across subgroups of patients with moderate-to-severe chronic plaque psoriasis of the hands and/or feet: post hoc analysis of REACH. J Eur Acad Dermatol Venereol. 2013; 28(7):882-90. PMC: 4229025. DOI: 10.1111/jdv.12198. View

Saraceno R, Pietroleonardo L, Mazzotta A, Zangrilli A, Bianchi L, Chimenti S . TNF-α antagonists and nail psoriasis: an open, 24-week, prospective cohort study in adult patients with psoriasis. Expert Opin Biol Ther. 2012; 13(4):469-73. DOI: 10.1517/14712598.2013.736960. View

Lebwohl M, Freeman A, Shane Chapman M, Feldman S, Hartle J, Henning A . Tacrolimus ointment is effective for facial and intertriginous psoriasis. J Am Acad Dermatol. 2004; 51(5):723-30. DOI: 10.1016/j.jaad.2004.07.011. View

Kumar B, Kumar R, Kaur I . Coal tar therapy in palmoplantar psoriasis: old wine in an old bottle?. Int J Dermatol. 1997; 36(4):309-12. DOI: 10.1046/j.1365-4362.1997.00176.x. View

10.

Campos M, Varela P, Baptista A, Moreira A . Inverse psoriasis treated with ustekinumab. BMJ Case Rep. 2016; 2016. PMC: 4885339. DOI: 10.1136/bcr-2016-215019. View

11.

Goldberg D, Chwalek J, Hussain M . 308-nm Excimer laser treatment of palmoplantar psoriasis. J Cosmet Laser Ther. 2011; 13(2):47-9. DOI: 10.3109/14764172.2011.564769. View

12.

BLEEKER J . Intralesional triamcinolone acetonide using the Port-O-Jet and needle injections in localized dermatoses. Br J Dermatol. 1974; 91(1):97-101. DOI: 10.1111/j.1365-2133.1974.tb06724.x. View

13.

Carrascosa J, Plana A, Ferrandiz C . Effectiveness and safety of psoralen-UVA (PUVA) topical therapy in palmoplantar psoriasis: a report on 48 patients. Actas Dermosifiliogr. 2013; 104(5):418-25. DOI: 10.1016/j.adengl.2013.04.005. View

14.

Sola-Ortigosa J, Sanchez-Regana M, Umbert-Millet P . Efficacy of adalimumab in the treatment of psoriasis: a retrospective study of 15 patients in daily practice. J Dermatolog Treat. 2011; 23(3):203-7. DOI: 10.3109/09546634.2010.519376. View

15.

Duweb G, Abuzariba O, Rahim M, Abdulla S . Occlusive versus nonocclusive calcipotriol ointment treatment for palmoplantar psoriasis. Int J Tissue React. 2001; 23(2):59-62. View

16.

Rigopoulos D, Gregoriou S, Makris M, Ioannides D . Efficacy of ustekinumab in nail psoriasis and improvement in nail-associated quality of life in a population treated with ustekinumab for cutaneous psoriasis: an open prospective unblinded study. Dermatology. 2011; 223(4):325-9. DOI: 10.1159/000334482. View

17.

Gumusel M, Ozdemir M, Mevlitoglu I, Bodur S . Evaluation of the efficacy of methotrexate and cyclosporine therapies on psoriatic nails: a one-blind, randomized study. J Eur Acad Dermatol Venereol. 2010; 25(9):1080-4. DOI: 10.1111/j.1468-3083.2010.03927.x. View

18.

Mehta B, Amladi S . 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. PMC: 3088933. DOI: 10.4103/0019-5154.77550. View

19.

Rigopoulos D, Ioannides D, Prastitis N, Katsambas A . Nail psoriasis: a combined treatment using calcipotriol cream and clobetasol propionate cream. Acta Derm Venereol. 2002; 82(2):140. DOI: 10.1080/00015550252948220. View

20.

Kavanaugh A, McInnes I, Mease P, Krueger G, Gladman D, Gomez-Reino J . Golimumab, a new human tumor necrosis factor alpha antibody, administered every four weeks as a subcutaneous injection in psoriatic arthritis: Twenty-four-week efficacy and safety results of a randomized, placebo-controlled study. Arthritis Rheum. 2009; 60(4):976-86. DOI: 10.1002/art.24403. View