Managing Psoriasis of the Hands: Palms, Knuckles, and Fingers | MyPsoriasisTeam

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Psoriasis on the Hands: Pictures, Symptoms, and Treatments

Medically reviewed by Kevin Berman, M.D., Ph.D.
Written by Laurie Berger
Updated on July 31, 2023

  • When psoriasis affects the hands, it can have a significant impact on everyday life and activities.
  • Psoriasis can affect the hands through palmoplantar psoriasis, palmoplantar pustulosis, and nail psoriasis.
  • Treating psoriasis on the hands may be more difficult than other parts of the body, but it can be managed with topical and systemic medications.

Do you have scaly skin on your palms that cracks and bleeds? Do you ever feel embarrassed to shake someone’s hand? Do you sometimes hide your hands at work?

When psoriasis hits the hands, it can feel devastating. Some 12 percent to 16 percent of people with psoriasis grapple with the skin disease on their hands and feet, according to the National Psoriasis Foundation. Palmoplantar psoriasis, as it’s known when it’s on the palms of the hands or soles of the feet, typically affects people with plaque psoriasis — the most common type of psoriasis.

Although palmoplantar psoriasis covers only a small area of the body, its impact on everyday life can be huge. Things like gripping a coffee cup, making a presentation at work, or shaking people’s hands can take a physical and emotional toll.

“My hands feel like they’ve been stung by 1,000 bees,” explained one member of MyPsoriasisTeam.

In fact, people with palmoplantar psoriasis are almost two and a half times as likely as people with psoriasis elsewhere on the body to experience difficulty completing regular daily activities, according to a 2018 study published in the Journal of the American Academy of Dermatology. “When psoriasis breaks out, cracks, and bleeds on the hands, you can't do much with them,” shared one MyPsoriasisTeam member.

Walking on feet with cracked and inflamed skin is also very painful. The study found that people with palmoplantar psoriasis were almost twice as likely to have mobility issues compared to people with psoriasis on other parts of their body.

Palmoplantar psoriasis is also difficult to treat, because mainstream psoriasis medications don’t work as well on thick, psoriatic skin of the palms and feet. Additionally, frequent hand-washing to protect yourself from infections from viruses or bacteria can worsen symptoms, causing cracks or sores that trigger flares (called the Koebner phenomenon). “My cracks are deep, and I cry when I wash,” said one member.

Types of Psoriasis on the Hands

Hand psoriasis can appear in various forms. It can show up as discolored, scaly sores on the palms, as pus-filled lesions (known as palmoplantar pustulosis), or as a combination of the two.

Palmoplantar Psoriasis

Characterized by thick, red or purplish plaques, this form affects around 12 percent to 16 percent of people with psoriasis and around 40 percent of people with plaque psoriasis. The fingernails are affected in cases of palmoplantar psoriasis up to 60 percent of the time.

Palmoplantar psoriasis can cause scabs, flaking skin, and deep cuts or fissures on the palms of the hands. (CC BY-NC-ND 3.0 NZ/DermNet)

Palmoplantar Pustulosis

This form of pustular psoriasis affects about 5 percent of people with psoriasis, and it can be severe. Small pus-filled blisters appear on the palms of hands and can later develop into painful, cracked plaques. The pus in this case does not indicate infection but rather is due to inflammation. A person can have palmoplantar pustulosis as well as other forms of psoriasis.

Palmoplantar pustulosis causes discolored, peeling skin with pus-filled blisters on the hands. (CC BY-NC-ND 3.0 NZ/DermNet)

Psoriatic Nail Disease

Thickening, crumbling, discoloration, pitting, and ridging of nails can occur with hand psoriasis. Nail disease, when accompanied by joint pain, may indicate psoriatic arthritis (PsA), a related condition. Symptoms can also be related to (or look like) a fungal infection in the nails and should be properly evaluated by a dermatologist.

Nail psoriasis, or psoriatic nail disease, can cause discoloration, crumbling, and brittle nails. (CC BY-NC-ND 3.0 NZ/DermNet)

Causes of Hand Psoriasis

Hand lesions, like psoriasis elsewhere on the body, are typically caused by an overactive immune system that creates inflammation and overproduction of skin cells, according to the American Academy of Dermatology Association.

Scientists believe genetic markers, specifically the human leukocyte antigen Cw6, are linked to the development of palmoplantar psoriasis. Environmental factors — including smoking, stress, skin traumas, and some medications — also play a role. Palmoplantar psoriasis can affect all ages and genders.

The exact cause of pustular psoriasis, however, is not known. The little blisters occur most frequently in people who smoke or used to smoke. Infection, pregnancy, some medications, and allergies may also trigger pustules on the hands.

Symptoms of Hand Psoriasis

Symptoms include itchy, scaling, discolored skin plaques with a defined, often symmetrical border. Deep, painful cracks or fissures in the skin are common. “Mine started with an ungodly itch and later changed to small, red bumps and small dry spots. Now my hands look like I’ve been burned — red, peeling, painful, and itchy,” explained one member of MyPsoriasisTeam.

Hand psoriasis can share some similar symptoms with hand dermatitis, dyshidrotic eczema, and other skin conditions, so they can easily be confused with one another. For this reason, it’s important to have any skin symptoms on your hands evaluated by a licensed dermatologist.

Diagnosis is made by visual inspection of the hands and an assessment of how much psoriasis appears elsewhere on the body. Skin scrapings may also be taken to rule out fungal infections, and a biopsy (skin sample for examination under a microscope) may be taken to confirm the diagnosis.

How Hand Psoriasis Affects MyPsoriasisTeam Members’ Lives

Members of MyPsoriasisTeam talk about feeling isolated, embarrassed, and depressed by psoriasis on their hands. They also share how it has affected their home, work, and social lives:

  • “My hands are constantly cut open. They feel like they were caught in a fire.”
  • “I’m so tired of hiding my hands.”
  • “Cleaning products wreak havoc on my hands.”
  • “I can’t hold my hands out for change [from a cashier]. They give me strange looks and drop it in my hand.”
  • “My hands and fingers feel like they have hot metal bands tightened around them.”
  • “I’m a registered nurse and people are always looking at my nails and hands. It’s so frustrating.”

Treatments for Hand Psoriasis

A doctor can prescribe general psoriasis treatments for hand lesions, but they’re not as effective in clearing scales on that part of the body. You may have to try several different oral and topical treatments before finding the right one for you.

Topical Treatments

Over-the-counter and prescription topical treatments (available as creams, ointments, or lotions) are often the first-line option for mild to moderate palmoplantar psoriasis. They’re typically prescribed in combination with moisturizers.

Over-the-Counter Topicals

Salicylic acid and coal tar are some low-potency ingredients found in nonprescription creams, gels, lotions, and soaps that can help manage mild to moderate hand symptoms.

Topical Steroids

High-potency topical corticosteroids can help reduce swelling and redness by inhibiting inflammatory responses in the body. They help lead to short-term remission (disappearance of symptoms) in about 20 percent of people with psoriasis on the hands.

Steroids come in various forms and strengths and should be used sparingly on small areas of the body for no longer than three weeks (or as your doctor instructed). Side effects can include skin thinning and changes in pigmentation. Because the skin on the hands is thick, these creams may be more effective — and absorb more quickly — if gloves or plastic wrap are layered on top of creams.

Nonsteroidal Topicals

Some nonsteroid prescription topicals that can be used to treat hand psoriasis include the vitamin A derivative tazarotene (Tazorac) and calcipotriene (Dovonex), a synthetic form of vitamin D. The U.S. Food and Drug Administration (FDA) approved VTAMA — a formulation of tapinarof — in 2022 as a nonsteroidal topical for plaque psoriasis that may be prescribed for palmoplantar psoriasis. These medications may be prescribed in alternation with steroids. Unlike steroids, these drugs don’t cause skin thinning.

Topical calcineurin inhibitors (TCIs), such as tacrolimus (Protopic) and pimecrolimus (Elidel), suppress the immune system to control inflammation and can be used longer than steroids. FDA-approved for atopic dermatitis, TCIs are frequently prescribed off-label to treat hand lesions in combination with topical steroids or systemic treatments.

Occluding — covering the area with cotton or plastic gloves after applying a topical — can increase the effectiveness of some topical medication. Check with your doctor before occluding, though. “Wearing white cotton gloves helps my hands, but draws attention and Michael Jackson jokes. Maybe I’ll dye them flesh-colored,” said one MyPsoriasisTeam member.

Phototherapy

Your doctor may prescribe phototherapy (light therapy) when palmoplantar psoriasis doesn’t respond to topical treatments. Psoralen UVA (PUVA), a drug combined with ultraviolet A light treatments, may be used more frequently than narrowband UVB because it penetrates more deeply.

Phototherapy is often combined with systemic treatments. Common side effects of phototherapy include discoloration and itching. Tacrolimus and pimecrolimus can increase the risk of sunburn. Phototherapy can also increase the risk of skin cancer. To minimize your UV exposure, ask your dermatologist about a UV unit that is made for the hands only.

DMARDs and Biologics

When standard treatment for hand psoriasis fails, a doctor may consider prescribing disease-modifying antirheumatic drugs (DMARDs) or biologic medications — drugs targeting proteins that cause inflammation. No one treatment works for every person, and you may have to try more than one medication or combination of treatments before finding one that relieves symptoms.

About 66 percent of palmoplantar psoriasis cases are severe, according to findings published in the journal Reumatologia. These cases may be treated with methotrexate — a DMARD that can be taken orally or as an injection. One study showed that 47 percent of people with palmoplantar psoriasis who were treated with methotrexate saw an improvement in their symptoms.

Cyclosporine, another DMARD, is a systemic drug that has proved effective in quickly clearing severe hand psoriasis, but it can be used only for a short time due to risk of renal (kidney) damage. The oral vitamin A retinoid acitretin (Soriatane or Neotigason) may help thin out thick plaques and dry up pustules for some people.

Biologic drugs offer a more targeted treatment approach as compared to traditional systemic medications like methotrexate or cyclosporine. However, scientists haven’t widely studied their effectiveness specifically in people with palmoplantar psoriasis. Examples of biologics include adalimumab (Humira), etanercept (Enbrel), and ixekizumab (Taltz). Biologics may increase the risk of infection and cancer. Some biologics may worsen pustular disease.

Hand Care Tips

Psoriatic hands can be easily irritated or injured, so it’s important to take extreme care with your skin. Using moisturizers, being gentle when washing your hands, and avoiding scratches or irritations are important.

Moisturizers

Moisturizers are an essential part of hand psoriasis treatment. These over-the-counter lotions, creams, and ointments help soften and remove dead skin cells. They can prevent psoriasis from getting worse. Apply moisturizers to skin at least once a day and at night following a warm bath or shower.

Members of MyPsoriasisTeam report good results with thick, hydrating creams and petroleum-based products, such as Vaseline, that form a protective seal over the skin’s surface. Thinner lotions will not be as emollient (softening and soothing), so look for thicker and greasier moisturizers to treat your hands.

“I put emollient on my hands, then Vaseline on top, to seal in moisture so they don’t split and crack. It seems to be working,” shared one member of MyPsoriasisTeam.

Another said, “I use Gold Bond Psoriasis Relief. I no longer scratch myself bloody, and I’m not ashamed to shake hands or let people see my hands.”

Hand-Washing

Frequently cleaning your hands to prevent the spread of viruses or bacteria makes good health sense. Health experts advise that people with hand psoriasis wash with soap and water rather than alcohol-based hand sanitizers, which can dry and irritate skin. Moisturize after hand-washing to reduce irritation from soaps, cleansers, and sanitizers.

“I have pustular psoriasis on the palms of my hands and find that ‘normal’ alcohol hand sanitizers cause flare-ups,” said one member of My PsoriasisTeam.

“I used sanitizer on my hands, and I screamed and wanted to cry,” shared another.

Choose gentle cleansers that are free of harsh chemicals or irritants, and rinse well. Residual soap can dry the skin and promote chapping and cracking.

You Are Not Alone: Finding Support for Hand Psoriasis

On MyPsoriasisTeam — the social network and online community for those living with psoriasis and their loved ones — more than 119,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriatic disease.

How does hand psoriasis affect your life? Has your doctor prescribed treatments to manage your symptoms? What creams or ointments have helped reduce scales and let you use your hands without pain? Share your tips and experiences in a comment below or on your Activities page.

Updated on July 31, 2023
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Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Laurie Berger has been a health care writer, reporter, and editor for the past 14 years. Learn more about her here.

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