Abstract :
Sir, Palmoplantar psoriasis is a condition characterised by erythema, infiltration, fissuring, and scaling, and is sometimes associated with recurrent crops of sterile pustules, occasionally presenting with hyperkeratosis. This chronic inflammatory skin disease can be disabling in cases where patients experience painful fissuring and may affect daily activities, possibly resulting in debilitating pain.1 Smoking has been observed to be a trigger in the development of this form of psoriasis through oxidative, inflammatory, and genetic mechanisms. Nicotine damages skin by increasing the reactive oxygen species and decreasing the expression of antioxidants. It also stimulates innate immune cells integral to the pathogenesis of psoriasis including macrophages, keratinocytes, and dendritic cells.2 A better understanding of palmoplantar psoriasis has disclosed some differences when compared to psoriasis vulgaris regarding age of onset, female predominance, and smoking influence.3 The impact of the cessation of smoking during the clinical course of the disease remains to be established. We present a case of refractory palmar psoriasis with clinical improvement after cessation of smoking.
