Painful, cracked feet

However, sometimes psoriasis can present as a keratoderma of the palms and soles with thick yellow keratin on the heels and forefoot. When thick keratin like this dries, it cracks and the cracks go straight down into the dermis causing local pain when walking. Patients may have very little evidence of psoriasis elsewhere. In newly acquired keratodermas, think also about lichen planus, pityriasis rubra pilaris – if there is an associated red scaly skin rash – and perimenopausal keratoderma. 

Treatment is with keratolytics such as 6%

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