Combined Fractional CO₂ Laser and Topical Corticosteroid Versus Topical Corticosteroid Only in the Treatment of Palmoplantar Psoriasis

To assess whether adding fractional laser to topical corticosteroid improves treatment outcomes in palmoplanter psoriasis compared to topical corticosteroid alone.

Inclusion criteria * Adults aged ≥18 years * Stable psoriasis * Confirmed cases of palmoplantar psoriasis (with or without psoriasis elsewhere) dermoscopically(Hand \_held dermoscopy) and histopathologically if required. * Willingness to comply with treatment and follow-up * Written informed consent obtained Exclusion criteria: * Other palmoplantar dermatoses (eczema, tinea, keratoderma) * Generlized Pustular psoriasis * Erythrodermic psoriasis * Use of: * Systemic antipsoriatic therapy within 3 months * Biologic therapy within 12 weeks * Topical treatment on palms/soles within 2 weeks * Pregnancy or lactation * History of photosensitivity disorders