1. All patients with clinically diagnosed cases of palmoplanter psoriasis attending KLES Dr. Prabhakar Hospital and Medical Research Centre, Belagavi will be recruited.

2. Informed consent will be taken from all the patients included in the study.

3. All patients in study will undergo a detailed history taking, general physical, systemic and dermatological examination.

4. Data will be collected by a single examiner and recorded in case record proforma.

5. Patients will be explained about the treatment offered in terms of expected results, duration of treatment, follow-ups, side effects to be reported, and prognosis of treatment.

6. Digital photographs of both palm and sole will be taken using identical camera settings, patients positioning and room lighting at baseline and at every sitting.

7. The process will be repeated every 4 weeks for a period of 12 weeks or >75% improvement in m-PPPASI score of the patient.

8. The list of side effects reported during the course of treatment will be treated accordingly. 

9. After 12 weeks digital photographs will be compared with that at the baseline.

10. Patient’s assessment of improvement will also be recorded for all patients.

11. Physician’s assessment will be classified as excellent, good, and poor. The improvement will be rated as poor, good, and excellent depending on the change in patient’s disease improvement.

12. Patient’s perceptions of improvement will be noted by using the visual analogue scale, where the patient was asked to mark on the line the point that they feel represents their perception of their current state.

13. Differences in final improvement by physician and patient’s perceptions will be analysed at the end of 12 weeks + 1 week or >75% improvement in m-PPPASI score to report percentage matching as successful result of treatment.

14. Group A will be given oral methotrexate 0.3 mg/kg/week not exceeding 25 mg/week while 23 patients in Group B will be given oral tofacitinib 5 mg BD.