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- Presentation
Hand and Foot Psoriasis, Dermatitis and Other Inflammatory Dermatoses: Introduction, Differential Diagnosis and Pustular Forms
Description
In this presentation, dermatologist Robert Bissonnette discusses hand and foot inflammatory skin diseases, with a primary focus on differential diagnosis related to conditions like psoriasis and eczema. Bissonnette highlights the complexities of diagnosing and treating skin lesions in palms and soles due to unique skin characteristics, such as a thicker stratum corneum and reduced access for topical treatments. He emphasizes the importance of identifying other potential causes of skin lesions and conducts a differential diagnosis for common and rare conditions, including infections and autoimmune diseases. The discussion includes insights into pustular palmoplantar psoriasis, noting that a significant number of affected patients are smokers and detailing potential biological and genetic factors involved. Bissonnette shares findings on gene expression differences in patients with pustular forms of psoriasis compared to non-pustular types, as well as the relevance of smoking cessation and oral health in managing palmoplantar psoriasis. He concludes with practical recommendations for effective patient care, urging thorough examination and consideration of various treatment options depending on the specific characteristics of the dermatosis observed.
View moreConclusions
- Diagnosis of inflammatory skin diseases on hands and feet can be challenging due to the unique characteristics of palmoplantar skin.
- Topical treatments may have limited effectiveness due to thick stratum corneum in these areas.
- Differential diagnosis should include various forms of dermatitis, infections, and less common skin conditions.
- Common inflammatory conditions include hand dermatitis which can be due to irritant or allergic reactions, and chronic hand eczema.
- Path testing is useful for chronic hand eczema cases to identify irritants and allergens.
- Lichen planus and Basex syndrome should be considered for atypical presentations. Cancer and infections must also be ruled out in chronic erythema or scaling cases.
- Pustular psoriasis and palmoplantar pustulosis share commonalities and may be considered part of the same disease spectrum.
- Smoking cessation is advised for patients with palmoplantar pustulosis due to its association with disease improvement.
- Molecular characterization shows potentially different immune profiles in psoriasis subtypes.
- Th1, Th2, and Th17 activations are increased in non-atopic chronic hand eczema, indicating a complex immune response.
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