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By Kirkland Lau, DO, Marnell Moore, DPM, and Stephen M. Schleicher, MD
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CASE:
A 61-year-old woman complains of a “growth” on her right heel. The affected area has been slowly expanding since the condition was first noticed approximately two months ago and is occasionally tender. Examining her foot, you note a well demarcated, slightly erythematous plaque with scale and scattered vesicles. Potassium hydroxide testing is negative.
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Localized pustular psoriasis is a rare type of psoriasis that affects the palms and soles. It is most frequently seen in middle-aged and older women. The pustules are sterile. The disorder may be triggered by infection or stress and is often painful enough to restrict mobility. Mild to moderate cases respond quite well to ultrapotent topical steroids and topical calcipotriene. When severe, the condition may require PUVA (psoralen plus ultraviolet A) or systemic therapy for adequate control. |
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Dr. Lau is an associate with a division of DermDx Centers for Dermatology in Sinking Spring, Pennsylvania. Dr. Moore is a podriatric surgeon at Englewood Hospital and Medical Center in Cresskill, New Jersey. Dr. Schleicher is director of DermDx Centers and a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia University in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 40(11):31-32, 2008
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