Palmoplantar Psoriasis Successfully Treated with Raw Natural Honey: A Case Report

P psoriasis is a disabling condition that is difficult to treat and is present in up to 40% of patients with plaque psoriasis.1 It is a disabling condition that can manifest in a hyperkeratotic plaque-type, pustular form or combination. In comparison with plaque psoriasis on other areas of the body, palmoplantar psoriasis leads to a disproportionately greater impairment of health-related quality of life (HRQoL).2 Psoriasis is a multifactorial condition influenced by numerous factors in its presence and severity, such as stress, exercise, alcohol, obesity, etc. Patients with palmoplantar psoriasis have difficulty walking, suffer a significant amount of pain in the palms and soles which may lead to an inability to work.2-4 Palmoplantar psoriasis typically represents a difficult to treat variety of psoriasis and unlike plaque-type psoriasis, pustular psoriasis is characterized by homozygous or compound heterozygous interleukin-36 (IL36RN) gene mutations leading to aberrations in IL-36R antagonist function.5 The thickened horny layer of palmar and plantar6 epidermis partially causes low bioavailability of classic topical anti-psoriatic drugs, hence the unsatisfactory results after prolonged usage. Systemic treatment on the other hand may include psoralen-UVA (PUVA), systemic retinoids and a combination of both,7,8 but they often fail to give convincing results.9 Tumor necrosis factor (TNF) antagonists are successfully being used in the treatment of psoriasis. However, unexpected side effect of TNF antagonists include the new onset or worsening of psoriatic skin lesions,10-15 eczematous eruptions, bacterial infections, herpes simplex, cutaneous lymphomas, lichenoid eruptions, erythema multiforme, acute generalized exanthematous pustulosis and lupus erythematosus pustulosis. Acitretin, cyclosporins lead to quick remissions but recurrence rate limits their wide application. Here we present a case report in which a patient with palmoplantar pustular psoriasis showed complete healing with raw natural honey.