Hand and Foot Psoriasis: Causes, Symptoms, Treatment

Psoriasis is a non-contagious autoimmune disorder, which is characterized by development of red, scaly and itchy abnormal patches on the skin. These skin patches may differ in severity, i.e. they may be small and localized or even cover the full body. Psoriasis commonly occurs on the scalp, elbows and knees. Psoriasis can also affect the palms, torso and soles of the feet.

When acute psoriasis flare-ups affect the hands or feet, especially the palms or soles, it is known as palmoplantar psoriasis or hand and foot psoriasis (HFP). It may also appear on the back of the hands, top of the feet and even on the knuckles and nails.

Although the feet and the hand make up only 4% of the body’s total surface area, psoriasis in these places can have a considerably big effect on the patient’s quality of life. Hand and foot psoriasis may cause tremendous pain and those scaly hands and feet may makes one feel uncomfortable and embarrassed in public. They might just want to keep the scales on their hands and feet covered all the time. Hand and foot psoriasis can inhibit the smooth functioning a person’s daily life.

Hand and foot psoriasis affects about 2 to 4% of the population across the globe and it affects men and women equally. Although hand and foot psoriasis may start at any age, it usually begins in adulthood and it heightens the risk of cardiovascular disorders, psoriatic arthritis, Crohn’s disease, lymphomas and depression. Studies have shown that 30% of psoriasis patients suffer from psoriatic arthritis.

Psoriasis is generally believed to be a genetic disease that is triggered by environmental factors where the immune system of the body reacts with the skin cells. The symptoms of hand and foot psoriasis generally worsen in winter, with psychological stress, infections and with certain medications like beta blockers NSAIDs. Dermal injury can also act as a potential trigger for psoriatic skin changes at that very spot. This is known as the Koebner phenomenon. It is characterized by skin cells which multiply up to 10 times quicker than normal. As the underlying cells reach the dermal surface and die, their volume causes elevated red plaques covered with white scales.

Hands and foot psoriasis (HFP) can also cause the skin to thicken, crack or split. It may cause redness and scaliness of the derma and swelling in the affected areas. Blisters or pimple like pustules may also appear on the affected regions. The fingernails and toenails get affected in most people and changes in nail colour or pits in the nails are often seen in hand and foot psoriasis.

Diagnosis of hand and foot psoriasis is typically based on the symptoms. Most often the doctor takes a painless swab or piece of skin from the affected region and tests it to diagnose psoriasis.

There is no known cure for hand and foot psoriasis or any other type of psoriasis. However, the symptoms of hand and foot psoriasis can be relieved in many ways. Patients should always keep their skin clean, well hydrated and nourished to treat the dryness and itchiness effectively. Mild soaps and soap substitutes along with medicated moisturizers should be used under the guidance of a doctor. Creams, ointments and gels containing coal tar, salicylic acid or corticosteroids can also be prescribed as these help in slowing skin growth, softening or reducing thick scales and easing the inflamed, itchy and scaly skin. About 75% of HFP symptoms can be managed with creams alone.

Ultra violet light therapy has also proven useful in easing the symptoms of hand and foot psoriasis. Various combinations of these treatments work more effectively than any one treatment alone. Doctors may at times also suggest the application of topical corticosteroids containing a type of vitamin D called calcipotriene. This medicine should, however, not be applied on the face and one should definitely wear gloves when applying it on the affected regions of their feet.

Since hand and foot psoriasis is an immune system condition, skin treatments may at times not prove to be effective. It is then that the doctor may recommend drugs, which will help to treat the disease at a cellular level. Immune suppressive drugs like Cyclosporine can help to slow down the overactive immune system while low-dose retinoids like acitretin (Soriatane) can help to decrease cell multiplication. Methotrexate can further help to slow the enzyme that is responsible for the rapid growth of dermal cells in foot psoriasis.

Hand and foot psoriasis is one of the most unpredictable, irritating and persistent skin disorders. Here are some things that an HFP patient can do to feel better:

• Quit smoking.
• The affected areas should be kept clean and well moisturized. Patients should only use moisturizing soaps and avoid using shower gel or bubble bath.
• The patients should wear vinyl gloves while working with water.
• They should only wear 100% cotton socks and avoid using shoes made from man-made products.
• Even minor injuries can harm the skin. If injured, one should only use waterproof bandages to cover the wound.
• They should relax and their hands and feet and give them ample rest.

Although psoriasis or hand and foot psoriasis cannot be cured fully, its symptoms can be considerably relieved with medication, therapy and topical application of creams, etc. With the right treatment and good care, psoriasis patients can live a normal life.

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