Hello. Thanks for writing to us at healthcaremagic Psoriasis affecting palms and soles is debilitating, hindering routine activities; it is responsible for significant social stigma as well. The psoriatic patches on palms, soles are dry/scaly and may develop painful fissures Or cracks Systemic treatment with oral Methotrexate is an option for recalcitrant palmoplantar psoriasis.It is well tolerated and is given in weekly doses. Methotrexate can be combined with topical treatment to hasten the resolution. However, methotrexate requires monitoring for side effects by blood tests (hemogram, Liver Function tests) I would suggest that you speak to your dermatologist for the needful Regards