ABSTRACT Background Palmoplantar psoriasis exhibits greater treatment resistance compared to other psoriatic plaques and presents clinical and histopathological overlap with palmoplantar eczema. This study aimed to investigate treatment resistance mechanisms in palmoplantar psoriasis and assess the contribution of IL‐17, IL‐23, and IL‐36α to the differential diagnosis of palmoplantar psoriasis and eczema. Immunohistochemical levels of these cytokines were measured in paired acral and non‐acral psoriatic samples. Methods We retrospectively included 73 patients: 25 with only palmoplantar psoriasis, 25 with palmoplantar eczema, and 23 with both conditions and concurrent plaque psoriasis. Clinical and histopathological diagnoses were confirmed. Immunohistochemical analyses were conducted using preparations stained for IL‐17, IL‐23, and IL‐36α. Results In psoriasis cases, immunohistochemical examination of biopsies from both body and palmoplantar regions showed lower IL‐17 and IL‐36α expression in acral regions compared to non‐acral regions. In palmoplantar eczema patients, IL‐17 and IL‐23 expression was higher than in palmoplantar psoriasis patients; however, IL‐36α expression was similar in both conditions. Conclusions The diminished expression of IL‐17 and IL‐36α in palmoplantar psoriasis compared to other body sites may contribute to variable responses to targeted treatments. These findings suggest the potential for developing distinct biological treatments for these regions.
Bulut et al. (2026) studied this question.