Hands, Feet and Nails
Treat acute flares of psoriasis on the hands and feet promptly and carefully. In some cases, cracking, blisters and swelling accompany flares.
Traditional topical treatment of palm and sole psoriasis includes tar, salicylic acid and corticosteroids. Combinations of these three agents may work better than using each individually. Moisturizers, mild soaps and soap substitutes also are often used.
Calcipotriene can also be effective to treat psoriasis on hands and feet. Wear cotton gloves so the medicine doesn't get on sensitive skin sites, such as the face or skin folds. A regimen alternating calcipotriene and potent topical corticosteroids may be helpful.
If topical medications do not work, your doctor may recommend methotrexate, cyclosporine or Soriatane (acitretin). Methotrexate can clear many cases of palm and sole psoriasis within four to six weeks.
The risks of side effects from phototherapy are reduced by combining low doses of oral retinoids with UVB or PUVA. The combination of low doses of oral retinoids with PUVA or UVB phototherapy is one of the most effective treatments available for palm and sole psoriasis. Special light therapy units for palms and soles are available.
Pustular psoriasis of the palms and soles
Topical treatments for pustular psoriasis such as corticosteroids and coal tar are usually prescribed first. Phototherapy, oral retinoids and/or methotrexate are also prescribed. Soriatane can be a helpful long-term solution for pustular psoriasis.
For difficult cases, doctors may prescribe a biologic drug.
Nail changes occur in up to 50 percent of people with psoriasis and at least 80 percent of people with psoriatic arthritis. The nail problems most commonly experienced by psoriasis patients are:
- Pitting—shallow or deep holes in the nail
- Deformation—alterations in the normal shape of the nail
- Thickening of the nail
- Onycholysis—separation of the nail from the nail bed
- Discoloration—unusual nail coloration, such as yellow-brown
Because psoriasis affects the nail when the nail is being formed, it is challenging to treat. The nail bed is difficult to penetrate with topical medications. Injections of corticosteroids into the nail bed have been used with varying results.
In addition to topical treatments and phototherapy, other treatments for nail psoriasis are:
- Corticosteroid injections into each affected nail;
- Cosmetic repair including nail scraping and filing, nail polish, artificial nails and surgical removal.
Onychomycosis, a fungal infection that causes thickening of the nails, may be present with nail psoriasis. It can be treated with systemic anti-fungal agents. About one-third of people who have nail psoriasis also have a fungal infection.
In most cases, keep the nails trimmed back with manicure scissors to the point of firm attachments. Keep nails as short as possible. Loose nails continue to be injured as they rub against surfaces. It is important to protect your nails from damage because trauma will often trigger or worsen nail psoriasis. One easy way to do this is to wear gloves while working with your hands.