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Hand and foot psoriasis is a particularly challenging form of the disease. It is both difficult to endure and difficult to treat.
Palmar-plantar psoriasis refers to involvement of the palms and/or soles of the feet with painful eruptions of psoriasis. The skin of the palms and soles can become thick, or consist of large, pimple-like pustules. The skin can also crack and split, which can be extremely painful or incapacitating. Smokers appear at greater risk of having palmar-plantar psoriasis.
Psoriasis can also appear on the tops of the feet and/or the backs of the hands, frequently on the knuckles and the nails. Hand psoriasis can make everyday tasks difficult or painful, and foot psoriasis can make walking painful.
While hand and foot psoriasis can be physically debilitating, its symptoms can also include emotional distress. Hand psoriasis is very visible and can make social interaction, particularly shaking hands, traumatic. If hand or foot psoriasis interferes with work, that also increases the emotional (and sometimes, financial) burden of this type of psoriasis.
While “severe” psoriasis has traditionally been defined as psoriasis that covers at least 10% of a person’s body surface area, experts have long noted that psoriasis covering just the hands or the feet is often “severe,” by nature of the unique challenges it poses. (Consider the attached photo of obviously-painful foot psoriasis, proof that a picture can be worth a thousand words.)
Treatment of Hand and Foot Psoriasis
Hand and foot psoriasis can be treated with the full range of psoriasis treatments, although hand and foot psoriasis can be especially resistant to treatment. There are certain treatment regimens that are more frequently tried for this type of psoriasis.
Topical creams and lotions, like topical steroids, are treatment mainstays. Sometimes, gloves are placed over the hands at bedtime after application of medicine; this is known as “occlusion.” But note, do not wrap or cover your skin like this unless directed to by your physician.
Ultraviolet light treatments are often used for hand and foot psoriasis. One method is to use special light machines that specifically target the hands and the feet. [See picture below from National Biological Corp.] These lamps can be equipped with traditional UVB, Narrow Band UVB or UVA bulbs. PUVA (ingestion of the drug psoralen plus UVA light) is another treatment sometimes used for hand and foot psoriasis.
Systemic medications are also used for hand and foot psoriasis. In particular, low-dose acitretin (Soriatane) plus PUVA is a combination treatment that has proven effective for many people with hand and foot psoriasis.
The biologics medications can also be appropriate for problematic hand and foot psoriasis. A recent study found that Raptiva helped many patients with hand and foot psoriasis.
You can listen to a podcast about hand and foot psoriasis and the Raptiva study here.
The key to fighting hand and foot psoriasis, as with so much of psoriasis--is persistence. If one treatment does not work for you, do not give up hope, keep looking. And make sure you are seeing a skilled dermatologist who has treated others with hand and foot psoriasis.
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