Treatment of Psoriasis on the Hands and Feet

Psoriasis is an inflammatory and chronic skin condition that typically affects the skin of the scalp, back, stomach, arms, and legs. In many patients, psoriasis affects the hands and feet.^[1]

Psoriasis on the Hands and Feet Affect Daily Activities

Psoriasis on the hands and feet (also known as palmoplantar psoriasis) can be particularly distressing as it is associated with greater physical discomfort and disability.^[2] Simple daily activities like walking, running, or opening a bottle can become painful. Patients with psoriasis on the hands and feet may have more problems mobility and with their daily activities.^[3] Compared to other forms of psoriasis, those with psoriasis on their hands and feet report a lower quality of life.^[3]

Protecting the Hands and Feet In Psoriasis

Moisture-wicking socks

Firstly, the hands and feet are constantly exposed to repeated pressures and injuries from daily activities. When it comes to footwear, moisture, and wetness can make the feet more susceptible to cracking. Therefore, your doctor may suggest socks that wick away moisture, such as socks that are made of materials like nylon, polyester, or merino wool since these fabrics wick away moisture better than 100% cotton.

Gloves

The hands are also exposed to constant pressure and friction from daily activities. Gloves may serve an important role in psoriasis by protecting the hands as a physical barrier during regular activities. Gloves may reduce injuries and friction to the hands.

Topical Medications Have to Be Applied Differently

Topical medications, like steroids, are typically applied to psoriasis lesions twice daily. This can be challenging on the hands and feet when the medications can make it messy for the rest of the day. Instead, your doctor may suggest that topical treatments be used once daily at night and the penetration of the medication can be enhanced with the use of cotton gloves on the hands and socks on the feet. This helps to keep the medication in place during the night so that it can soak into the skin better.

Treatment of Excessive Sweating

For those that suffer from excessive sweating (hyperhidrosis) on the hands and feet due to hyperhidrosis, treatment can reduce the moisture and sensitivity of the feet and hands. Treatment options should be discussed with a dermatologist and may include topical and/or oral medications or botulinum toxin injections to the palms and soles to reduce sweating. In one small study, botulinum toxin was shown to improve psoriasis in the armpits^[4] but there have not been any studies looking at whether botulinum toxin injections into lesions of psoriasis improves psoriasis on the hands and feet. Aluminum chloride is prescribed as a topical drying agent in those with hyperhidrosis, but it may be too irritating when used on the hands and feet in those with psoriasis, especially if there are cracks on the skin.

Psoriasis can be a frustrating and embarrassing skin condition and perhaps even more debilitating in those that have involvement of the hands and feet. Extra care to the hands and feet can make a positive difference to the condition and a local health provider or dermatologist can help in choosing the best treatment options.