Treatment of Scaling and Itching Palmar Lesions

Initial Assessment and Diagnosis

The American Academy of Dermatology recommends determining the underlying cause of hand eczema/dermatitis, which presents with vesicles, scaling, erythema, and fissuring 1
Palmoplantar psoriasis shows well-demarcated erythematous plaques with thick silvery scale and hyperkeratosis, according to the American Academy of Dermatology 3, 4
Irritant or allergic contact dermatitis from occupational exposures or hand hygiene products should be considered, as stated by the American Academy of Dermatology 1

The American Academy of Dermatology suggests applying clobetasol propionate 0.05% cream or ointment twice daily to affected areas, with a strength of evidence based on clinical trials 1, 2
Urea 10% cream should be applied three times daily to all affected areas, including after hand washing, for its humectant and keratolytic effects, as recommended by the American Academy of Dermatology 1, 2
The "soak and smear" technique, which involves soaking hands in plain water for 20 minutes and then applying moisturizer to damp skin, can enhance penetration, according to the American Academy of Dermatology 1

The American Academy of Dermatology advises avoiding mechanical and chemical irritants that perpetuate hand dermatitis, such as minimizing hand washing frequency and avoiding very hot or cold water 1
Using protective gloves for wet work and applying moisturizer underneath, as well as avoiding known irritants like dish detergent and harsh soaps, is recommended by the American Academy of Dermatology 1
Wearing cushioned gloves when performing activities involving mechanical stress can help prevent hand dermatitis, as suggested by the American Academy of Dermatology 2

The British Association of Dermatologists recommends referring patients with cases not responding to topical therapy after 4 weeks for topical PUVA (psoralen plus UVA) therapy, which achieves clearance or considerable improvement in 58-81% of dyshidrotic eczema and 50-67% of hyperkeratotic eczema 5, 4
Treatment typically requires 2-3 sessions weekly for several months, with oral PUVA being superior to UVB for hand eczema but carrying increased long-term skin cancer risk, as stated by the British Association of Dermatologists 5, 4

The American Academy of Dermatology suggests initiating acitretin 25 mg daily for severe palmoplantar psoriasis with significant quality of life impairment, which demonstrates significant improvement in scaling, thickness, and erythema within 2 months of treatment 3, 4
Monitoring lipid panels is necessary, as elevations in triglycerides and cholesterol are common but manageable with fibrates or statins, according to the American Academy of Dermatology 3