Your hands and feet may be the hardest-working parts of your body. They are in almost constant motion and continuously interact with the world. So if they are affected by psoriasis, your quality of life may be more severely impaired than if psoriasis struck elsewhere on your body. Lesions, scaling and blisters in the delicate folds of fingers or on the soles of the feet can be agonizing and hard to hide.
Treating Psoriasis on Your Hands and Feet
For mild flareups, washing your hands and feet with a mild soap or soap substitute can keep them clean with minimal irritation. Superficial splits in the skin can be closed with an Over-The-Counter (OTC) medical glue (such as New-Skin Liquid Bandage, although this and other products like it may sting when placed in skin fissures) to prevent inflammation and infection. Moisturizers can help to maintain skin flexibility and reduce itching.
What Your Doctor Can Do
To reduce more severe inflammation, itching and scaling, your doctor may prescribe any of the following topical treatments alone or in combination:
- Medicinal coal tar can slow the overgrowth of skin cells and improve the appearance of the skin. It is available OTC in a variety of lotions, creams and bath solutions under such brand names as Elta Tar and Oxipor. Allow approximately 8 weeks for results. It is worth noting, though, that coal tar is difficult to find in California because of a concern that it may cause cancer. The FDA, though, has approved products containing up to 5% coal tar as a safe and effective psoriasis treatment.
- Salicylic acid helps to reduce scaliness. It comes in a variety of forms, including soaps and ointments. Dermarest is a common brand name. If necessary, formulas with stronger salicylic acid concentrations can be prescribed by your doctor.
- Corticosteroids, the most common topical treatment for psoriasis, work to reduce the redness and swelling of lesions. Steroid creams come in a variety of strengths. The palms and soles are the thickest, least delicate skin, so potent steroids are typically prescribed for these areas, although it is important to note that strength is not necessarily indicated by its concentration.
In order for topical treatments to be most effective, it may be necessary to remove excess layers of skin first, so that the treatment can be properly absorbed. Try soaking the affected area in warm water -- adding some bath oil to the water may help -- and follow up with a thorough scrubbing to slough off any scales or calluses. When scrubbing, be careful not to scrub scales too hard because traumatizing the skin may actually make psoriasis worse.
To intensify the effects of a topical treatment, your doctor may recommend occlusion, which means insulating the treated area for a period of time. This can be achieved by using cotton or plastic gloves on the hands and plastic bags covered by socks on the feet. This should only be done if a doctor recommends it , as occlusion can result in a dangerously excessive absorption of the medicine.
If topical treatments are ineffective in more severe cases of psoriasis of the hands or feet, your doctor may choose other treatments, for example, methotrexate, Psoralen Ultraviolet A (PUVA) and Soriatane. Your doctor will advise you that methotrexate is a powerful drug that can have potentially dangerous side effects, especially ones that could damage your liver. PUVA is a process that involves taking a drug that sensitizes you to light and then exposes the affected skin to ultraviolet rays. For Soriatane, please speak with your dermatologist about whether it is a good choice for you.
Fingernails and Toenails
In up to 50% of psoriasis sufferers, changes will be seen in the fingernails and toenails. Symptoms include pitting in the nail surface, discoloration or thickening of the nail and separation of the nail from the nail bed.
These changes are caused by effects of psoriasis at the base of the nail, where the nail is formed. Since this is a difficult spot to reach, topical treatments are typically ineffective. More effective treatments include steroid injection into each nail and controlled exposure to UVA rays. Biologics are also a good option. Neither of these is a permanent solution, so those with a milder case may choose to treat the problem cosmetically (by buffing out an uneven surface or wearing nail polish, for instance), if at all.
Up to 30% of psoriasis sufferers will develop psoriatic arthritis, a condition that causes pain, stiffness and swelling in the joints. Treatment options include biologics, which are becoming the treatment of choice, prescribed Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and steroid injections in the affected areas.
The joints of the ankles and feet are particularly vulnerable to psoriatic arthritis and may sometimes cause swelling to the point that shoes are uncomfortable or impossible to wear. If you find that changes in your ankles and feet are making it difficult to go about your daily life, consult a podiatrist.
Sources:National Institutes of Health Staff. "Psoriatic Arthritis." NIH.gov. 27 Apr. 2007. National Institutes of Health. 7 May 2008. <http://www.nlm.nih.gov/medlineplus/ency/article/000413.htm>.
National Psoriasis Foundation Staff. "Overview." Psoriasis.org. 2008. National Psoriasis Foundation. 7 May 2008. <http://www.psoriasis.org/about/>.
National Psoriasis Foundation Staff. "Psoriasis on the Hands and Feet." Psoriasis.org. 2008. National Psoriasis Foundation. 7 May 2008. <http://www.psoriasis.org/about/psoriasis/sites/hands_feet.php>.
National Psoriasis Foundation Staff. "Psoriasis on the Nails." Psoriasis.org. 2008. National Psoriasis Foundation. 7 May 2008. <http://www.psoriasis.org/about/psoriasis/sites/nails.php>.