What Are The Symptoms Of Psoriasis
The signs and symptoms of psoriasis can vary depending on the type of psoriasis you have. The 5 most common symptoms of psoriasis include:
- Rashes or patches of red, inflamed skin, often covered with loose, silver-colored scales in severe cases, the plaques will grow and merge into one another, covering large areas.
- Itchy, painful skin that can crack or bleed
- Small areas of bleeding where the involved skin is scratched
- Problems with your fingernails and toenails, including discoloration and pitting the nails may also begin to crumble or detach from the nail bed.
- Scaly plaques on the scalp
Psoriasis can also be associated with psoriatic arthritis, which causes achy, swollen joints. Between 10% and 30% of people with psoriasis also have this painful joint condition.
How Is Hand Psoriasis Diagnosed
It would be really easy if doctors could take a skin sample and know without question what kind of skin issue you were dealing with. Of course, its unfortunately not that simple if you potentially have psoriasis on your hands.
While biopsies can help confirm psoriasis on other parts of the body, its not a good test when we are trying to differentiate it on the hands and feet, Dr. Rosmarin explains. Its really important to look at the symptoms, he says.
Thats not to say that a doctor may not recommend taking a biopsy if they want to try another diagnostic option. There arent a lot of studies about the differences between eczema and palmar psoriasis under a microscope, but a smaller 2015 study published in The Journal of Dermatology found there were some key differences. These include white-to-gray scales for those with palmar psoriasis or brown-orange dots for those with hand eczema.6
How Do You Treat Psoriasis On The Hands
Treatments are aimed at relief of symptoms of psoriasis on the hands, though there is no cure.
Treatments for other types of psoriasis such as TNF-alpha inhibitors including infliximab and adalimumab may trigger palmoplantar pustulosis and are generally not prescribed.
Topical treatments mild psoriasis on the hands may include:
- Emollients
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Heat Rash: Sweating That Leads To Bumpy Red Skin
Inverse psoriasis is a type of psoriasis that forms in the armpits and skin folds under breasts or in groin areas, making the skin red and shiny. Sweating makes this type of psoriasis worse. Heat rash also makes your skin red and forms in skin folds of the groin, breasts, and armpits. Heat rash occurs in hot, humid conditions. Sweating can cause your pores to get blocked and result in a bumpy, red skin rash that stings. Heat rash is more common in newborns, but can also affect older children and adults.
The Early Signs Of Plaque Psoriasis
Skin issues and changes are common, but sometimes what looks like nothing more than a little patch of redness or a bit of dry skin can really be a sign of something more serious. And it could be that your skin issues are actually a condition affecting your entire body and health.
Thats the case with plaque psoriasis, an autoimmune condition that initially appears to be a skin disorder. Psoriasis affects you far below the surface of your skin, causing inflammation and other serious health issues and 7.5 million people in the U.S. live with it daily¹.
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Psoriasis With Darker Skin
You can get psoriasis with all different skin colors, but it tends to look different on darker skin.
In African Americans, psoriasis is typically purplish in color with scaling that looks gray. In very dark skin, the psoriasis may also be dark brown and so harder to see.
Slightly lighter Hispanic skin tends to produce a dark pinkish-colored psoriasis and with a scale that looks silvery-white.
In addition, after psoriasis clears on these skin types, patches that are lighter or darker than the surrounding skin may remain for some time .
These are not scars, and they will clear after some time, though it can take from a few months to a year or longer. Your skin doctor may be able to treat them so they clear more quickly. Ask about this if the appearance of the patches bothers you.
Show Sources
Jeffrey M. Weinberg, MD, director of the Clinical Research Center, St. Luke’s-Roosevelt Hospital Center, New York City assistant clinical professor of dermatology, Columbia University College of Physicians and Surgeons consultant for Amgen and Genentech.
National Institute of Arthritis and Musculoskeletal and Skin Diseases.
American Academy of Dermatology.
Sneaky Psoriasis Sign #: Hand Or Foot Blisters
Raised red patches on the palms or soles are common with psoriasis, but an unlucky few develop deep blisters or pustules within these patches, says Dr. Katta. This is known as palmoplantar pustular psoriasis.
Smokers are at higher risk for this type, because nicotine can cause inflammation in the sweat glands of the hands and feet.
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Can Psoriasis Affect Only My Nails
In some cases, psoriasis may involve only the fingernails and toenails, although more commonly, nail symptoms will accompany psoriasis and arthritis symptoms. The appearance of the nails may be altered, and affected nails may have small pinpoint pits or large yellow-colored separations on the nail plate called “oil spots.” Nail psoriasis can be hard to treat but may respond to medications taken for psoriasis or psoriatic arthritis. Treatments include topical steroids applied to the cuticle, steroid injections at the cuticle, or oral medications.
Mild To Moderate Cases
Mild to moderate palmoplantar psoriasis may be treated with topical treatments, including:
- Emollient moisturizers: Apply thinly and frequently to treat dry, itchy, flaky skin and help prevent cracking.
- Salicylic acid: This keratolytic agent, available in lotions, soaps, foot balms, and shampoos, promotes the shedding of scales and reduces thickened plaques.
- Coal tar: Lotions, creams, and shampoos with this ingredient can reduce inflammation and slow skin growth.
- Anti-itch creams, containing ingredients like camphor, menthol, or benzocaine
- Calcipotriene: A vitamin D derivative, this appears to slow the hyperproduction of skin cells and reduce inflammation.
- Topical corticosteroids: Apply sparingly to temper local inflammation and reduce the size and appearance of plaques.
To improve absorption, a technique called occlusion may be used in which the hands or feet are covered with cling film, plastic gloves, or a plastic bag for several hours or overnight.
Speak with your healthcare provider about the appropriate use of occlusion to prevent skin irritation or the supersaturation of the skin .
A topical drug sometimes used to treat psoriasis, called anthralin, is not very successful for palmoplantar psoriasis. Anthralin is messy and impractical, requiring prolonged treatments, and may further dry and irritate delicate skin.
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How Is The Diagnosis Of Palmoplantar Psoriasis Made
Palmoplantar psoriasis is diagnosed by its clinical appearance, supported by finding chronic plaque psoriasis in other sites. Mycology of skin scrapings may be performed to exclude fungal infection. Skin biopsy is rarely needed.
The differential diagnosis of palmoplantar psoriasis includes:
- Other forms of acquired keratoderma.
Generalised Pustular Psoriasis Or Von Zumbusch Psoriasis
This causes pustules that develop very quickly on a wide area of skin. The pus consists of white blood cells and is not a sign of infection.
The pustules may reappear every few days or weeks in cycles. During the start of these cycles, von Zumbusch psoriasis can cause fever, chills, weight loss and fatigue.
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Measles: A Facial Rash That Can Cover The Body
Like guttate psoriasis, measles also follow symptoms of an upper respiratory infection in children and cause a skin rash of small, red spots. However, the measles skin rash usually starts on the face and spreads down to cover the body and is accompanied by fever, cough, and a runny nose. Measles rash is also flat, while the rash of psoriasis is typically raised. Measles is caused by a virus and is contagious, though the measles vaccination has made this a rare disease in the United States.
Who Will Be Responsible For My Healthcare
Youre likely to see a team of healthcare professionals.
Your doctor, usually a rheumatologist, will be responsible for your overall care. And a specialist nurse may help monitor your condition and treatments. A skin specialist called a dermatologist may be responsible for the treatment of your psoriasis.
You may also see:
- a physiotherapist, who can advise on exercises to help maintain your mobility
- an occupational therapist, who can help you protect your joints, for example, by using splints for the wrist or knee braces. You may be advised to change the way you do some tasks to reduce the strain on your joints.
- a podiatrist, who can assess your footcare needs and offer advice on special insoles and good supportive footwear.
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What Are The Types Of Psoriasis
Common types of psoriasis include:
Plaque psoriasis. This is the most common type of psoriasis. It causes plaques and silvery scales, usually on the knees, elbows, lower back, and scalp. They can be itchy and painful and may crack and bleed.
Guttate psoriasis. This type often shows up after an illness, especially strep throat. It causes small red spots, usually on the trunk, arms, and legs. Spots also can appear on the face, scalp, and ears.
Inverse psoriasis. This causes smooth, raw-looking patches of red skin that feel sore. The patches are in places where skin touches skin, such as the armpits, buttocks, upper eyelids, groin and genitals, or under a girl’s breasts.
Work And Psoriatic Arthritis
Having psoriatic arthritis may make some aspects of working life more challenging. But, if youre on the right treatment, its certainly possible to continue working.
Help and support is available, and you have rights and options.
The Government scheme Access to Work is a grant that can pay for equipment to help you with activities such as answering the phone, going to meetings, and getting to and from work.
The 2010 Equality Act, and the Disability Discrimination Act in Northern Ireland makes it unlawful for employers to treat anyone with a disability less favourably than anyone else. Psoriatic arthritis can be classed as a disability if its making every-day tasks difficult.
Your employer may need to make adjustments to your working environment, so you can do your job comfortably and safely.
You might be able to change some aspects of your job or working arrangements, or train for a different role.
In order to get the support youre entitled to, youll need to tell your employer about your condition. Your manager or HR department might be a good place to start.
Other available support might include:
- your workplace occupational health department, if there is one
- an occupational therapist. You could be referred to one by your GP or you could see one privately
- disability employment advisors, or other staff, at your local JobCentre Plus
- a Citizens Advice bureau particularly if you feel youre not getting the support youre entitled to.
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Reduced Range Of Motion
One possible sign of PsA is a reduced range of motion in your joints. You might find it harder to extend your arms, bend your knees, or bend forward.
You may also have problems using your fingers effectively. This can lead to problems for people who work with their hands in any way, including typing and drawing.
When the joint becomes permanently fixed or unable to move beyond a certain point, its known as a contracture deformity. This can lead to complications such as:
- Dupuytrens contracture, a thickening of the tissue layer beneath the skin in the hands and wrist
- Volkmanns contracture, or lack of blood flow to the forearm that causes muscle shortening
Prevention involves range of motion exercises prescribed by a doctor or done with a physical therapist.
Fatigue is a common symptom in people with PsA. You may begin to have difficulty making it through the day without taking a nap.
According to a , up to 50 percent of people with skin conditions report having moderate to severe fatigue, while 25 percent experience severe levels of fatigue.
In the case of PsA, fatigue may be due to symptoms or complications like:
- inflammation
How Arthritis In The Hands Is Treated
If youre diagnosed with an inflammatory form of arthritis, you have more treatment options than someone with OA. While nonsteroidal anti-inflammatory drugs can help manage the pain of both types of arthritis, the development of disease-modifying antirheumatic drugs and biologics has vastly improved the prognosis of those with inflammatory forms of arthritis by reducing inflammation and preventing further joint damage.
Cortisone injections can be useful for those with OA and conditions such as RA, though theyre usually used in patients whose inflammatory arthritis is limited to just one or two joints, Dr. Byram says. Injections of hyaluronic acid can be helpful for those with OA , but these are better for managing pain in larger joints like the knees rather than the hands.
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What Else Should I Ask My Healthcare Provider
If you have psoriasis, ask your healthcare provider:
- How can I prevent outbreaks and control symptoms?
- What medication will work best for me?
- What else should I do to improve symptoms?
- What are my options if creams dont work?
- Will psoriasis ever go away?
A note from Cleveland Clinic
Psoriasis, an itchy skin condition, can come and go throughout your life. Its related to an overactive immune response and is not contagious. If you have skin changes that arent going away, talk to your healthcare provider. There is no cure for psoriasis, but psoriasis treatments can improve symptoms. Your provider may prescribe a special cream or moisturizer or medications. Other therapies are available if creams or medicines dont work. Maintaining your overall health will also help improve symptoms.
Last reviewed by a Cleveland Clinic medical professional on 10/17/2020.
References
Articles On Types Of Psoriasis
Knowing which kind of psoriasis you have helps you and your doctor make a treatment plan. Most people have only one type at a time. Sometimes, after your symptoms go away, a new form of psoriasis will crop up in response to a trigger.
In general, most types of psoriasis result from the same triggers:
- Diet
- Weather
Here’s how you can spot the 7 types of psoriasis and what you can do to treat them.
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What Injections Or Infusions Are Available For Psoriasis
Recently, a new group of drugs called biologics have become available to treat psoriasis and psoriatic arthritis. They are produced by living cells cultures in an industrial setting. They are all proteins and therefore must be administered through the skin because they would otherwise be degraded during digestion. All biologics work by suppressing certain specific portions of the immune inflammatory response that are overactive in psoriasis. A convenient method of categorizing these drugs is on the basis of their site of action:
Drug choice can be complicated, and your physician will help in selecting the best option. In some patients, it may be possible to predict drug efficacy on the basis of a prospective patient’s genetics. It appears that the presence of the HLA-Cw6 gene is correlated with a beneficial response to ustekinumab.
What Are The Causes And Triggers Of Hand Psoriasis
Doctors dont know exactly what causes psoriasis on the hands. Instead of one specific cause, theres likely a combination of genetic and environmental factors that play a role in its development. These include:1
- Genetics, specifically variations on the human leukocyte antigen Cw6, which is a gene partly responsible for immune system activity
- Friction to the palms, such as if you work with hand tools
- History of trauma or injury to the palms
- Irritants, such as exposure to chemicals
- Smoking
Those who work with their hands are most likely to have the condition, such as farmers, manual laborers, massage therapists, and environmental services professionals.
Many of the potential causes for hand psoriasis are also triggers for the condition, but there are a few other things that can cause a flare-up. Pay special attention to seasonal changes, household work, laundry detergent, and stress, as these can all make hand psoriasis worse. Another thing to consider is whether your nightly glass of wine has anything to do with psoriasis flare-ups. According to one 2019 study published in the journal Psoriasis, drinking alcohol has been linked to flare-ups in general, not just on the hands.4
Its tough when your livelihood is causing your hand psoriasis symptoms. Talk to your doctor or workplace if there may be adjustments that could reduce your flare-ups. Examples include protective gloves, padding tools, or reassignment to a different job duty.
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An Itching Or Burning Feeling On The Skin
Although psoriasis patches arent usually irritating, some people do report itchiness. People who have psoriasis of the scalp can report its very itchy or dry, says Anthony Rossi, MD, FAAD, a board-certified dermatologic surgeon at Memorial Sloan Kettering Cancer Center and assistant professor of dermatology at Weill Cornell Medical College.
The itching and pain can interfere with basic daily activities including self-care, sleep, and even walking.
Can Psoriatic Arthritis Affect Other Parts Of The Body
Having psoriatic arthritis can put you at risk of developing other conditions and complications around the body.
The chances of getting one of these are rare. But its worth knowing about them and talking to your doctor if you have any concerns.
Eyes
Seek urgent medical attention if one or both of your eyes are red and painful, particularly if you have a change in your vision. You could go to your GP, an eye hospital, or your local A& E department.
These symptoms could be caused by a condition called uveitis, which is also known as iritis. It involves inflammation at the front of the eye.
This can permanently damage your eyesight if left untreated.
Other symptoms are:
- blurred or cloudy vision
- sensitivity to light
- not being able to see things at the side of your field of vision known as a loss of peripheral vision
- small shapes moving across your field of vision.
These symptoms can come on suddenly, or gradually over a few days. It can affect one or both eyes. It can be treated effectively with steroids.
Heart
Psoriatic arthritis can put you at a slightly higher risk of having a heart condition. You can reduce your risk by:
- not smoking
- staying at a healthy weight
- exercising regularly
- eating a healthy diet, thats low in fat, sugar and salt
- not drinking too much alcohol.
These positive lifestyle choices can help to improve your arthritis and skin symptoms.
Talk to your doctor if you have any concerns about your heart health.
Crohns disease
Non-alcoholic fatty liver disease
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