Treating Psoriasis on the Hands or Feet

If you have an acute psoriasis flare-up on your hands or feet, see your doctor ASAP. He'll work with you until you find something that helps.

Psoriasis on these areas is most likely to show up on the palms and soles. This is called palmar-plantar psoriasis. But it can also appear on the tops of your feet, backs of your hands, and on knuckles and nails.

Small Area, Big Impact

Your hands and feet make up only 4% of your body's total surface area. But psoriasis here can still have a big effect on your quality of life. You might have pain, or you may just want to cover up the scales. If it affects your work, that could lead to a financial burden as well.

Hands and feet psoriasis (HFP) can also cause your skin to:

  • Crack or split
  • Thicken
  • Redden
  • Scale
  • Swell
  • Blister or have pimple-like spots (pustules)

Medications That Treat Your Skin

Here are some common ways to treat psoriasis on the hands and feet and relieve your symptoms.

In addition to moisturizers, mild soaps, and soap substitutes, your doctor may recommend:

  • Coal tar products, like creams, gels, or ointments, to slow skin growth and ease itchy, inflamed, or scaly skin
  • Salicylic acid, a peeling agent that softens or reduces thick scales
  • Corticosteroids, often creams and ointments

Combinations of these often work better than one treatment alone. Sometimes doctors suggest alternating or using topical corticosteroids with a type of vitamin D called calcipotriene. This medicine should not be used on the face, so be sure to wear gloves when applying to your hands and feet in order to avoid getting it on your face later. 

Your doctor might have you use a corticosteroid under a type of dressing called hydrocolloid occlusion. This filmy layer bonds to the cream, helps keep skin moist, and can be worn for several days.

Medications That Stop Disease Progress

Psoriasis is an immune system condition, so if skin treatments don’t work, your doctor may recommend drugs that affect the disease at a cellular level. These include:

  • Cyclosporine, to slow down your overactive immune system
  • Low-dose retinoids like acitretin (Soriatane), to reduce cell multiplication
  • Methotrexate, which slows an enzyme that causes the rapid growth of skin cells in psoriasis

Continued

Doctors often combine retinoids with light therapy for hands and feet psoriasis. You might have UVB or psoralen-UVA (PUVA) phototherapy or targeted phototherapy (laser treatment). PUVA involves taking the drug psoralen, either by mouth or applied like paint, along with the light therapy.

If these treatments don’t work, your doctor may prescribe a type of medication called a biologic, which targets specific parts of the immune system. Different types of psoriasis respond in different ways to these medications. Examples include:

Pustular Psoriasis on the Palms and Soles

Some people -- mostly adults who smoke -- get pustular psoriasis on their palms and soles. Known as palmoplantar pustulosis (PPP), it can erupt over months or years. It may also cause painful cracks, redness, and scales. It can be more stubborn to treat than other types of hand and foot psoriasis, but the same methods are used.

Psoriasis and Your Nails

Psoriasis can also affect your nails as they form. It could cause:

  • Shallow or deep holes
  • Shape changes
  • Thickening
  • Separation of the nail from the nail bed
  • Discoloration

Corticosteroid creams or ointments and light therapy are also used to treat nail psoriasis. If these don’t get the job done, your doctor might suggest corticosteroid injections into your nail beds. Nail psoriasis can cause fungal infections -- your doctor will prescribe anti-fungal agents.

Cosmetic repair is also an option. This can involve:

  • Nail scraping and filing
  • Nail polish
  • Artificial nails
  • Surgical removal

To help prevent problems, trim your nails as short as possible, and wear gloves when you work with your hands.

WebMD Medical Reference Reviewed by Stephanie S. Gardner, MD on July 21, 2016

Sources

SOURCES:

Di Lernia, V. Dermatology Online Journal , 2010.

FDA. "FDA approves new psoriasis drug Taltz."

National Psoriasis Foundation: "Specific locations: Hands and feet."

The Psoriasis Association: "Pustular Psoriasis."

Wound Care Advisor: “What you need to know about hydrocolloid dressings.”

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