Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Palmoplantar Psoriasis

Discussion in 'General Issues and Discussion Forum' started by ginger, Jul 14, 2011.

Tags:
  1. ginger

    ginger Active Member


    Members do not see these Ads. Sign Up.
    I have a 63 year old female patient who has been diagnosed with palmoplantar psoriasis. She has no noteable previous medical history. She is taking Simvastatin (20mg) and Losartan (100mg).
    She had a previous flare up of the psoriasis in 2008, the flare up started immediately after her daughters wedding. She is convinced this incident was helped by accupuncture.
    Her current flare up has lasted since February 2009 and is showing no signs of improvement. I see her every 3 weeks to reduce the build up of callous around her medial heel area, apices of toes and 1st IPJ's. Her right foot is worse affected than her left. She has no pustules present but suffers from intensive pruritus which cause her to scratch until her skin bleeds. She has deep fissures around her heels and areas of raw skin, particularly around her heels and in her MLA, her forefoot is not as badly affected as the rearfoot.
    She has seen 5 Dermatologists and has tried various creams and ointments including 2 coal tar preparations (one containing salacylic acid) which she describes as "messy and unproductive" and hydrocortisone cream. For the past few months she has been using Simply Feet cream and Dermatonics Heel Balm which has 25% urea, her right foot has improved but her left remains a problem. She has tried accupuncture again as she felt this helped the original flare up but has had no success this time. She is now suffering from mild to moderate depression as a result of the problems her feet (and hands) are causing her and is getting desperate. She is willing to try anything (she has even in the past bathed her feet in her own urine after reading it might help!!!). I realise photos would have been a plus here, I will get photos when she is in next time and post them.
    This lady is not keen on taking tablets at all. UV therapy has been mentioned to her but it is not available where we live.
    If anyone had ANY ideas or experience of this at all it would be very much appreciated. I hope I have provided enough information for you:eek:
     
  2. Admin2

    Admin2 Administrator Staff Member

    Related threads:
    Other threads tagged with psoriasis
     
  3. drfoot2

    drfoot2 Active Member

    Dear Ginger, I feel sympathetic to your patients condition and symptoms she is suffering with. I had a massive flare about a year ago, after changing brand of gloves. I thought it was a latex allergy or to the powder of the glove.
    Without going into long winded tx, I was initially treated with oral steroids and topical creams, for an allergic rash. This did not help and was referred to a Dermatologist, who diagnosed severe hand and foot Psoriasis. I had no other sites affected, but the palms and soles were horrendously affected. Later latex allergy tests proved -ve.
    I was then changed to Methotrexate which only made me feel worse. UV tx for 6 weeks had no improvement. I was at my wits end. The saving treatment was Neotigason 10mg. Initially once daily for 6 mths, now tapering back to 10mg twice weekly. For me this has been a saving grace. Psoriasis management is really dependant on the patient. I have since worked closely with my Dermatologist, in that I have had many of my patients referred to him, and with his feedback, patients respond differently to varied tx regimes. Speak to your patient re Neotigason. I would be interested in her progress. I can give you my Dermo's details if you are Melbourne based.
     
  4. ginger

    ginger Active Member

    Thanks very much dr! I will pass that information on to her. Glad to hear your problem is improving.
     
  5. gr8feet

    gr8feet Member

    can you post some pictures?
    It is nice when it comes to things Dermy
    Thanks
     
  6. ginger

    ginger Active Member

    I will, I meant to take my camera with me for her last appointment, usually always carry it but typically it had been taken out of my bag and I forgot to put it back in. She'll be back in 2 1/2 weeks again so I'll get some pics then.
     
  7. Ian Harvey

    Ian Harvey Active Member

    I also have a client with severe fissures in the plantar foot. Her dermatologist has not yet given a diagnosis, but I am treating the deep, painful fissures with debridement and Liquiheel (surgical superglue). This gives substantial pain relief for between 2 and 4 weeks. Hope this helps.

    Ian.
     
  8. ginger

    ginger Active Member

    Double post, sorry!
     
  9. ginger

    ginger Active Member

    Thanks for that. My patient has had the use of glue suggested to her by a dermatologist but she wasn't keen on the idea. :confused:
    I will certainly suggest the idea to her again though. Thank you.
     
  10. ginger

    ginger Active Member

    Can I ask how much you charge for a liquiheel treatment? Do you add extra on top of your usual charge or do you have a specific treatment charge? Thank you.
     
  11. Ian Harvey

    Ian Harvey Active Member

    No prob. It can be slightly messy during debridement (a bit of blood) but the glue appears to bond with the fluids, as well as the tissue to form an effective dressing. If done correctly,the patient can stand pain free immediately, and also have showers without any problems. Bit expensive. Google liquiheel.

    Regards,
    Ian.
     
  12. Ian Harvey

    Ian Harvey Active Member

    Prices vary. I believe that some charge £50 or more on top of the usual charge. I just add £15 on top at present.
    Ian.
     
  13. ginger

    ginger Active Member

    Thanks so much. I have been having a look around indeed :) I might invest in some and offer it as a treatment, just to see if people are interested. She could have a trial go then.
     
  14. Kyrret

    Kyrret Active Member

    I have great smypathy for your patient as I suffered from this problem myself about 10 years ago. Walking was agony and I could only drive with plastic gloves on as turning the steering wheel caused cracks to open on my hands. I had never had psoriais before and can only think that it was caused by stress (it was when I was deciding to change careers from teaching to chiropody). My Gp prescibed an ointment called something like Diprosalic. I'm not convinced that it was effective. I used to sleep with my feet in plastic bags to keep the ointment on my feet and off the sheets. The flare up subsided after about 6 months and (touch wood) I have not had any reoccurrance.
     
  15. ginger

    ginger Active Member

    I do suspect there was a stress element at the start of this flare up. It may be a bit of a catch 22 situation where stress may have started the flare up and now the stress of the flare up itself is causing it to remain....
     
  16. an elderly patient of mine gave me this recipe which he said cured his psoriasis- i have passed it on to several desperate psoriasis sufferers but have no idea if they tried it or if it helps-this is it
    30ml. pure raw sesame seed oil
    12 drops of cajepot oil
    6 drops of benzoin oil
    8 drops lavender oil mix and apply to skin
     
  17. blinda

    blinda MVP

    Why wasn`t she keen? `Superglue` was initially developed to heal wounds during the Vietnamese war. Liquiheel is a medical grade tissue adhesive, ideal for fissures in Psoriasis. I published case studies for this product, which included 3 patients who had severe Psoriatic fissures and the adhesive immediately reduced pain levels and provided a sterile dressing allowing the wounds to heal.

    Cheers,
    Bel
     
  18. ginger

    ginger Active Member

    Thanks Bel. I'm really not sure of the exact reasons she wasn't keen. I think it was the 'idea' of it and she was worried it would sting her already painful skin. I will definitely put all this forward though, I really appreciate everyone's comments!
     
  19. ginger

    ginger Active Member

    Thanks Peter, she has tried something very similar to this but I will pass on the 'recipe' to her also.
     
  20. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    308-nm Excimer laser treatment of palmoplantar psoriasis.
    Goldberg DJ, Chwalek J, Hussain M.
    J Cosmet Laser Ther. 2011 Apr;13(2):47-9.
     
  21. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Treatment of palmoplantar psoriasis with infliximab: a randomized, double-blind placebo-controlled study.
    Bissonnette R, Poulin Y, Guenther L, Lynde CW, Bolduc C, Nigen S.
    J Eur Acad Dermatol Venereol. 2011 Dec;25(12):1402-8. doi:
     
  22. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    This clinical trial was just registered:
    Apremilast in Palmo-Plantar Psoriasis
     
  23. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Apitherapy as a New Approach in Treatment of Palmoplantar Psoriasis.
    El-Gammal E et al
    Open Access Maced J Med Sci. 2018 Jun 10;6(6):1059-1061.
     
Loading...

Share This Page