Finding Relief from Psoriasis on Your Hands and Feet

Palmoplantar psoriasis symptoms and treatments are similar to general psoriasis, but there are some unique tips to consider. In this article, we’ll explore the details and share real-life advice from people who know what you’re going through.

Psoriasis (PsO) on the hands and feet, also called palmoplantar PsO, can be very difficult to treat since you’re constantly using these body parts and they’re highly exposed to the environment. Palmoplantar PsO may even cause more physical disability than PsO cases on other parts of the body.

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Symptoms of palmoplantar PsO

Psoriasis on your hands and feet has similar symptoms to psoriasis on other parts of the body. These typically include:

• raised red or silvery plaques
• scaling of the skin
• itching or burning
• pain
• cracking and bleeding of the skin

These symptoms may or may not be associated with:

• small fluid-filled pustules
• generalized PsO or PsO plaques on other parts of your body
• nail changes such as pitting, ridging, and thickening

Treatment for palmoplantar PsO is also similar to treatment for plaque PsO, with a few different techniques and preferred treatments.

Treatments for palmoplantar PsO

Finding the right treatment can be tricky, as it can take several months to see improvement in the skin. Additionally, medications can be very costly and have significant side effects. Treatment options usually include topical treatments, light therapy, and systemic medications (oral or injected).

Topical treatments

Topical treatments, like creams and ointments, can help — but sometimes they don’t penetrate the thicker skin that we have on our hands and feet.

Applying these with an occlusive dressing, like a Band-Aid or even clear plastic wrap (yes, the one in your kitchen) works well to help really lock them in place. Covering these dressings overnight with a pair of gloves or socks is also a good idea.

Some topical treatments used for palmoplantar PsO include:

• topical corticosteroids
• vitamin D analogs, like calcipotriene
• topical retinoids
• anthralin
• salicylic acid
• coal tar
• moisturizers and emollients

Light therapy

Using targeted ultraviolet (UV) light, or phototherapy, directly on your hands and feet can help control the overgrowth of skin cells that cause the thick, scaly, and often painful plaques. This is usually a second-line treatment, used when topical treatments have failed.

Phototherapy is typically prescribed by a dermatologist and involves regularly exposing the affected skin to UV light under medical supervision.

PsO of the hands and feet is one of the most responsive types of PsO to this type of treatment.

Sunlight

Both UVA and UVB rays are found in natural sunlight, but UVB works best for PsO.

UVB from the sun works the same way as phototherapy treatments, but it’s difficult to target only small parts, like the hands and feet. Also, spending more time in direct sunlight can increase your chance of a sunburn, which can trigger the Koebner phenomenon, and even certain skin cancers.

Some topical medications, like tazarotene and coal tar, can also increase your risk of sunburn.

It’s important to note that commercial tanning beds typically emit more UVA rays, which are not the kind that help PsO. UV exposure from tanning beds and sun lamps can damage the skin, cause premature aging, and increase the risk of skin cancer.

Systemic medications

Systemic medications (oral or injected) that treat the whole body may help control palmoplantar PsO by achieving generally clearer skin or even remission of your PsO altogether. These medications include:

• methotrexate, oral or injectable form
• cyclosporine (Sandimmune)
• oral retinoids, like Soriatane (Acitretin)
• oral apremilast (Otezla)
• oral tofacitinib (Xeljanz)
• biologic medications

Take routine care of your hands and feet

Keeping your skin well-hydrated by applying a moisturizer daily, especially after bathing, can help the overall health of the skin on your hands and feet.

Use thicker creams or emollients that lock in the moisture and are free of perfumes and dyes.

It’s also a good idea to avoid hot water, as it can aggravate your skin and make your symptoms worse. Keep an eye out for the National Psoriasis Foundation seal of recognition when buying products.

Identify and avoid your triggers

Try to identify things that make your palmoplantar PsO worse and try to avoid them.

Consider everything from the soaps you use when away from home, the keyboards you touch, your steering wheel cover, medications, and stress levels.

Protect your hands and feet when possible

Wearing sunscreen on your hands and feet whenever you’re outdoors or in direct sunlight for long periods of time can help.

Wearing gloves when doing household chores to avoid exposing them to chemicals, irritants, abrasive surfaces, or very hot water is also a good idea.

Also, consider wearing protective and comfortable footwear whenever possible to avoid friction and injury to your feet.

Seek medical treatment

Be sure to see your healthcare professional or specialists regularly and communicate your concerns. The best way to manage palmoplantar PsO is to find an effective regimen that leads to significantly clearer skin or even remission.

Taking care of your overall health is also important when managing PsO.

Seeing your primary care provider (PCP) regularly for those evidence-based screenings is important to help find and treat diseases early and reduce the condition’s impact on your overall quality of life.

The bottom line

The impact that psoriasis has on your life can be significant. But making healthy lifestyle choices and seeking proper medical treatment can help minimize these effects.

Combining these approaches can help manage or even alleviate your palmoplantar psoriasis, and potentially your psoriasis symptoms overall.