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Psoriasis på hænderne kan være med til at begrænse dig i hverdagen både fritid og på arbejdet. Derudover ser man ofte at personer med psoriasis på hænderne ikke deltager i nogen former for fysisk aktivitet, hvilket i nogle tilfælde medfører overvægt.
Sværhedsgraden af psoriasis måles efter både de fysiske og psykiske konsekvenser. Derudover anses det for at være svær psoriasis, hvis mere end 10% af kroppen er ramt, moderat psoriasis hvis 3-10% af kroppen er ramt og mild psoriasis hvis 2% er ramt.
Mange førende eksperter mener, at personer med psoriasis på hænder og fødder skal behandles anderledes end personer med mere generaliserende psoriasis. Det skyldes udelukkende, at personer med psoriasis på hænderne ofte er så påvirket i deres sociale, private og arbejdsliv, at de har svært ved at fungere optimalt. Hudlidelsen svækker simpelthen denne gruppe til at udføre funktioner i dagligdagen, som er helt normale for mange andre.
Få effektive og nemme råd til at bekæmpe psoriasis - direkte i din indbakke.
Parapsoriasis describes a group of cutaneous diseases that can be characterized by scaly patches or slightly elevated papules and/or plaques dispersed on the trunk or proximal extremities that have a resemblance to psoriasis—hence the nomenclature. However, this description includes several inflammatory cutaneous diseases that are unrelated with respect to pathogenesis, histopathology, and response to treatment. Because of the variation in clinical presentation and a lack of a specific diagnostic finding on histopathology, a uniformly accepted definition of parapsoriasis remains lacking.
In 1902, Brocq initially described 3 major entities that fit the description:
Pityriasis lichenoides variants describe scaly dermatoses with necrotic papules that are clinically and histologically different from parapsoriasis. These diseases generally are benign and undergo spontaneous resolution but, at times, may have a protracted course (see Pityriasis Lichenoides for further discussion).
Current terminology of parapsoriasis refers to 2 disease processes that are caused by T-cell–predominant infiltrates in the skin. These disease processes are large plaque parapsoriasis and small plaque parapsoriasis.
As the nomenclature and description of the disease spectrum under the descriptive term parapsoriasis evolved, the primary focus has been on the distinction of whether the disorder progresses to mycosis fungoides (MF) or cutaneous T-cell lymphoma (CTCL). Small plaque parapsoriasis is a benign disorder that rarely if ever progresses. Large plaque parapsoriasis is more ominous in that approximately 10% of patients progress to MF/CTCL.  Controversy exists currently in the classification of large plaque parapsoriasis because some believe it is equivalent to the earliest stage CTCL, the patch stage. [2, 3, 4]
The duration of parapsoriasis can be variable. Small plaque disease lasts several months to years and can spontaneously resolve. Large plaque disease is chronic, and treatment is recommended because it may prevent progression to CTCL.
El-Darouti et al reported on a 7-year study of a hypopigmented disorder that the researchers believe should be classified as a new variant of parapsoriasis en plaque. 
No clear etiology for small plaque or large plaque parapsoriasis is known, and no specific association has been made with contact exposure or infections.
For more information, see the topic Psoriasis.
The initiating cause of parapsoriasis is unknown, but the diseases likely represent different stages in a continuum of lymphoproliferative disorders from chronic dermatitis to frank malignancy of cutaneous T-cell lymphoma (CTCL).
Small plaque parapsoriasis likely is a reactive process of predominantly CD4 + T cells. Genotypic pattern observed in small plaque parapsoriasis is similar to that observed in chronic dermatitis, and the pattern of clonality of T cells is consistent with the response of a specific subset of T cells that have been stimulated by an antigen. Multiple dominant clones can be detected by polymerase chain reaction (PCR) of T-cell receptor gene usage, which supports a reactive process. Lymphocytes do not show histologic atypia to suggest malignant transformation. Southern blot analysis of T-cell receptor genes from parapsoriasis does not identify a dominant clone of T cells.
Some physicians believe that small plaque parapsoriasis is an abortive T-cell lymphoma; however, no clear distinguishing evidence, such as genetic changes (eg, TP53 mutations) observed in other malignancies, exists to support this contention.  Nevertheless, a hint to the verity of this hypothesis is the recent identification of increased telomerase activity in T cells from CTCL at low-grade stages, high-grade lymphoma, and parapsoriasis, which is activity not exhibited in normal T cells. A better understanding is likely to develop from further molecular characterization. 
Large plaque parapsoriasis is a chronic inflammatory disorder, and the pathophysiology has been speculated to be long-term antigen stimulation. This disorder is associated with a dominant T-cell clone, one that may represent up to 50% of the T-cell infiltrate. If the histologic appearance is benign, without atypical lymphocytes, classification of large plaque parapsoriasis is made. If atypical lymphocytes are present, many would classify such patients as having patch stage CTCL.
In one study, human herpesvirus type 8 was detected in up to 87% of skin lesions of large plaque parapsoriasis. This is the first association of a specific infectious agent with large plaque parapsoriasis, and the significance is unclear. Further studies are important to determine the significance of this finding. 
The close relationship between large plaque parapsoriasis and mycosis fungoides is highlighted by the detection of TOX expression, a new marker that has been described to be frequently detected in the abnormal T cells in mycosis fungoides. In one study, large plaque parapsoriasis has expression of TOX similar to that of mycosis fungoides. 
Dr Hannah Gronow, 17 Jan 2018
Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Psoriasis article more useful, or one of our other health articles.
Synonyms: psoriasis palmoplantaris, psoriasis palmaris et plantaris
Psoriasis predominantly affecting the palms and soles takes two forms:
- Erythematous scaly plaques typical of psoriasis elsewhere in the body.
- More generalised thickening and scaling (keratoderma).
Palmoplantar pustulosis (PPP) is a chronic inflammatory skin condition. It is considered by some to be a variation of psoriasis and occurs in patients with other types of psoriasis . However, the nature of the link with psoriasis is unclear and there are significant differences. Neuroendocrine dysfunction of the sweat glands has been implicated in the pathogenesis . See the 'Palmoplantar pustulosis' section at the end of this article.
See also separate Psoriatic Nail Disease article.
The prevalence of psoriasis has increased in the UK in recent years. It was 2.3% (2,297 cases per 100,000) in 1999 but 2.8% (2,815 per 100,000) in 2013 . There was, however, no associated increase in incidence. This suggested that patients with psoriasis were living longer, although reasons for this are unclear. A proportion of these patients, usually with psoriatic lesions elsewhere, will have psoriasis involving the feet and hands.
- Red scaly plaques.
- Hyperkeratotic areas.
- Central palm or weight-bearing areas of the soles.
- Well demarcated.
- Painful cracking and fissuring.
See also separate Chronic Plaque Psoriasis article.
- Classical psoriatic lesions can be treated with a vitamin D ointment (calcipotriol/Dovonex® or tacalcitol/Curatoderm®) or dithranol (Dithrocream®/Micanol®).
- In palm and sole psoriasis, both hyperkeratosis and inflammation are usually present and may require separate treatments:
- Hyperkeratosis usually needs to be treated with a keratolytic agent such as 2% salicylic acid ointment BP.
- This can be alternated morning and evening with a topical steroid (usually potent, due to the thick skin at this site) .
- Where there is diagnostic uncertainty.
- For further patient counselling and education.
- Where topical treatment has failed, or treatment has not been tolerated.
- Where there is significant physical, psychological, social or occupational difficulty.
Further treatment options in secondary care include low doses of oral retinoids with psoralen combined with ultraviolet A (PUVA) or UVB phototherapy, methotrexate, ciclosporin or acitretin. Calcineurin inhibitors such as tacrolimus or pimecrolimus and biological agents such as infliximab and alefacept have been used with some success .
Pain can restrict the use of hands or walking.