Hands, Feet and Nails
Psoriasis on the hands and feet can lead to cracking, blisters and swelling. There are several treatments that can help psoriasis in these areas. A few lifestyle changes also can ease the discomfort of hand, feet and nail psoriasis.
Treating Hands and Feet
Treat acute flares of psoriasis on the hands and feet promptly and carefully.
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 can help.
Calcipotriene can also effectively 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.
In some cases, cracking, blistering and swelling accompanies flares. Consider super glue to seal deep fissures. If you suspect you might have a super glue allergy, do a little patch test on your bicep first, said Cynthia Tricket, a physician's assistant for Texas Dermatology Associates.
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.
Listen to our webcast on treating psoriasis on the hands and feet to learn more »
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 most common nail problems 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 it is being formed, nail psoriasis is challenging to treat. The nail bed is difficult to penetrate with topical medications. Corticosteroid injections into the nail bed have been used with varying results. In addition to topical treatments and phototherapy, other nail psoriasis treatments 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.
Keep nails as short as possible. Loose nails can continue to be injured if 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. Trickett recommends wearing cotton gloves under vinyl or nitrile gloves when you are cleaning, cooking or washing dishes. Latex gloves are not recommended.