Palmoplantar pustular psoriasis

• There is no ideal treatment for chronic palmoplantar pustular psoriasis but there is RCT evidence to support the use of topical corticosteroid under hydrocolloid occlusion, systemic retinoids, systemic PUVA, and systemic retinoids in combination with systemic PUVA. Of these, the last appears to give the greatest chance of disease control.

• There is some evidence that modest improvements may be attained with low-dose ciclosporin, tetracycline antibiotics, and Grenz ray therapy.

• There is little evidence to support the use of colchicine, topical PUVA, hydroxyurea or methotrexate.

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