Palmoplantar psoriasis is a rare subtype of psoriasis. It is a chronic, relapsing, inflammatory, immunologically-mediated disease affecting the palms and soles.

This is a case of a 58-year-old female with multiple, well-defined, yellowish plaques on slightly erythematous base with some fissures on bilateral palmoplantar areas affecting 4% of body surface area. On Dermatology Life Quality Index, she scored 14. She was advised biopsy but deferred. The lesions were also tested with potassium hydroxide for fungal elements, yielding positive results. She was initially managed as tinea pedis et manuum with three pulse doses of oral antifungal medication for three months. With minimal improvement, patient finally consented for biopsy, confirming diagnosis of psoriasis. She was subsequently treated with potent topical corticosteroids and narrowband-ultraviolet B localized phototherapy, leading to a complete clearance of lesions after 16 weeks of steroid treatment and 52 sessions of phototherapy. There was no more erythema, plaques and fissures, with affected BSA down to 0% and DLQI score to 1. Three months post-treatment, there is still no recurrence of lesions.

Palmoplantar psoriasis is an uncommon variant of psoriasis featuring hyperkeratotic plaques and fissures limited to the palms and soles with associated significant functional impairment. It can be difficult to diagnose, often mistaken for other diseases, and is typically resistant to treatment with poor long-term remission. Biopsy plays a crucial part in the effective management especially among patients with refractory disease. There are numerous treatment modalities but psychosocial needs are equally important to be addressed.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Biopsy ; Corticosteroid ; Adrenal Cortex Hormones ; Phototherapy

BACKGROUND. ITP is an acute disease in children characterized by bleeding manifestation with spontaneous remission. However, some develop severe bleeding which maybe life threatening.

OBJECTIVE. To determine the difference in proportion of patients who achieved a rise in platelet count in patients with acute immune thrombocytopenic purpura treated with corticosteroids or IVIG.

METHODS. A systematic search of articles utilizing a search strategy was performed to identify relevant articles according to prior inclusion and exclusion criteria. Data sources included Medline, EMBASE, Cochrane, Pediatric Hematology and Oncology, Pediatrics and Journal of Pediatrics (all up to 2005). Fixed effects and random effects models were used to determine summary effects estimates.

OUTCOME MEASURE. Difference in proportion of patients who achieved the desired platelet count between treatment groups.

RESULTS. Analysis of 9 randomized controlled trials showed that IVIG produced an additional 12-14% increase in proportion of patients with platelet count >20 x 10 9/ L and 18% increase in proportion of patients with platelet count >50 x 10 9 / L on days 2 to 4. No significant differences were seen between the treatment groups on days 14 and 28 except for platelet count >50 x 10 9 /L.

CONCLUSION. IVIG is more effective than corticosteroids in raising the platelet count during the early part of treatment.

Immune Thrombocytopenic Purpura ; Corticosteroid ; Intravenous Gamma Globulin ; Meta-analysis