Palmoplantar psoriasis can be managed with a combination of topical therapies as detailed earlier, including corticosteroids, salicylic acid, and tar. This patient was initially treated with topical therapies because he was young and treatment-naive. He received a combination of triamcinolone acetonide, 0.1% (a midpotency topical steroid medication), and urea cream, 10% (a topical keratolytic medication). Steroids are a mainstay of many dermatologic conditions but are often used for short bursts; in general, hands and feet have thick skin, so midpotency to high-potency topical steroids can be used for 4 to 6 weeks with appropriate breaks in between. Lower potency topical steroids with bland emollients or alternate nonsteroid mediations can be used during periods when there is no flare-up of the condition. Keratolytics, such as urea and topical vitamin D analogues (eg, calcipotriol), are often used to decrease the level of scaling, reduce inflammation, and allow penetration of the topical steroids. The patient in this case improved significantly within 1 week of treatment initiation, with less redness, scaling, and pain, and did not require intensified therapy. Phototherapy and, in particular, topical psoralen in combination with UV-A has been successful for more recalcitrant disease. Methotrexate sodium, oral retinoids, biologics such as etanercept and alefacept, and short courses of cyclosporine have also been documented as effective for severe recalcitrant palmoplantar psoriasis.4 In a retrospective review of treatment responses of palmoplantar psoriasis,5 one group showed that, although topical agents remain the most widely used treatment modality, the disease is frequently resistant to topical therapies and may require multiple systemic agents.