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Treating Psoriasis on the Hands or Feet

If you have an acute psoriasis flare-up on your hands or feet, get prompt medical attention. Although psoriasis on the hands and feet may be somewhat resistant to treatment, continue working with your doctor to find something that works.

Psoriasis on the hands and feet often appears on the palms and soles (called palmar-plantar psoriasis). But psoriasis can also appear on the tops of your feet, backs of your hands, and on knuckles and nails.

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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. It can cause everything from pain and trouble walking to embarrassment about unsightly lesions. If it affects your work, you may suffer a financial burden, as well. 

In addition to pain, hands and feet psoriasis (HFP) can cause:

  • Cracking and splitting
  • Thickening
  • Redness
  • Scaling
  • Swelling
  • Blisters or pimple-like spots (pustules)

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

Topical Psoriasis Treatment for Hands and Feet

In addition to moisturizers, mild soaps, and soap substitutes, your doctor may recommend topical treatments such as:

  • Coal tar products, including creams, gels, or ointments, to slow skin growth and reduce inflammation, itching, and scaling
  • Salicylic acid, a peeling agent used to soften and reduce thick scaling 
  • Corticosteroids, often creams and ointments, sometimes applied under a special type of dressing called hydrocolloid occlusion as directed by the doctor

Combinations of these often work better than any one treatment alone. Sometimes doctors suggest alternating topical corticosteroids with calcipotriene. This is a type of vitamin D. Wear cotton gloves when applying it. This helps avoid getting it into sensitive spots such as on your face.

Systemic Psoriasis Treatment for Hands and Feet

Sometimes topical treatment is unable to penetrate the area where it's needed. If so, your doctor may recommend other medications. These may include:

  • Methotrexate, which inhibits an enzyme involved in the rapid growth of skin cells
  • Cyclosporine, which suppresses the immune system
  • Low-dose retinoids such as acitretin (Soriatane), which helps control the multiplication of cells

Doctors often combine retinoids successfully 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. Your doctor can tell you about special light therapy units or laser treatments for the palms and soles of the feet.

If these treatments fail, your doctor may prescribe a medication that targets specific parts of the immune system (biologics). Different subtypes of psoriasis may respond in different ways to these medications. Examples include:

  • Adalimumab (Humira)
  • Etanercept (Enbrel)
  • Infliximab (Remicade)
  • Ustekinumab (Stelara)

Although found effective for hand and feet psoriasis, efalizumab (Raptiva) has been pulled from the market because of safety concerns.

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