Types Of Psoriasis On Hands And Feet

Treatment For Psoriasis On The Feet

If you think that you might have psoriasis on your feet, make an appointment with a podiatrist or a dermatologist. These experts can help determine whether psoriasis or another condition may be causing your dry, flaky, itchy feet. Clinical examination of your skin and possibly a skin biopsy will help confirm the diagnosis.

If psoriasis is determined to be the cause of your symptoms, there are several ways you and your doctor can help alleviate your discomfort. Keep in mind that it may take a while to find the right treatment.

Take Care Of Your Feet

Start by taking good care of your feet. Wash them regularly with a gentle soap that does not dry the skin or trigger flares. Your doctor can offer medical advice to help you find a soap that will work for you. If you are particularly prone to outbreaks of psoriasis on your feet, an oatmeal foot bath may also soothe your skin.

When your feet are clean and dry, use a gentle moisturizer to keep your feet well hydrated. Some lotions with urea or salicylic acid are specifically designed for people diagnosed with psoriasis.

Pustular Psoriasis Of Pregnancy

Pustular psoriasis of pregnancy, also called impetigo herpetiformis, is a very rare variant. It can be life threatening for the mother and fetus if its not treated.

Pustular psoriasis of pregnancy most often appears early in the third trimester. It can reappear in future pregnancies, usually at an earlier stage.

Symptoms may include:

• pus-filled bumps on the inner thighs and groin that join together and spread
• pustules in the mouth and under the nails

Although the exact cause is unknown, some possible risk factors may be a family history of psoriasis or a gene mutation triggered by increasing levels of progesterone.

Your treatment will depend on the type of pustular psoriasis you have and how serious it is. Sometimes it takes several tries or a combination of treatments to find the most effective approach.

Your doctor will probably prescribe ointments first because they can soothe your skin and reduce inflammation.

UV light, both natural and artificial, is used to treat psoriasis. PUVA therapy is a combination of UV light and psoralen, an oral medication that makes your skin more sensitive to it. PUVA stands for psoralen plus ultraviolet A.

Your doctor may also prescribe medications like:

• acitretin , an oral retinoid
• cyclosporine
• tumor necrosis factor-alpha blockers like infliximab , adalimumab , and etanercept
• interleukin-12/23 inhibitors like ustekinumab

TNF-alpha blockers and interleukin-12/23 inhibitors belong to a group of powerful drugs known as biologics.

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What Causes Pustular Psoriasis

At the risk of sounding like a broken record, genes are to blame. But researchers have dug deeper and discovered a specific gene mutation that may be responsible for pustular psoriasis.

A study in the American Journal of Human Genetics IDd the gene AP1S3. If you have this particular genetic predisposition, the triggers for pustular psoriasis are often infection, stress, hormonal changes such as pregnancy, and exposure to chemicals. Also, certain drugs such as OTC pain relievers and anti-inflammatory drugs, penicillin, and some antidepressants such as lithium can trigger a flare. Stopping a course of steroids too fast can bring on a flare of pustular psoriasis, too.

Can You Have Psoriasis On Fingers Or Nails

Psoriasis most commonly affects the palms of the hands. They may appear inflamed with dry, thickened skin. The thick areas may have cracks or fissures. Sometimes, this appearance is similar to that of a fungal infection, like athletes foot, but on the hands.

About 60% of people who have psoriasis on their hands also experience changes to their fingernails.1David Rosmarin, M.D., a dermatologist and assistant professor at the Tufts University School of Medicine, tells SELF changes from nail psoriasis may include:

• Lifting of the nail plate from the nail bed
• Oil spots
• Pitting
• White spots

While the psoriasis lesions may also appear on the knuckles and fingers, the palms are usually the originating area. When psoriasis extends to your fingers and knuckles, this can make it especially difficult to maintain the function in your hands, as it can be painful.

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What Causes Nail Psoriasis

Of all the people who have some type of psoriasis, up to 50% will also have nail psoriasis. Like scalp psoriasis, it often comes along with plaque psoriasis, but it can also accompany other types or appear all on its own, too. Those with psoriatic arthritis will have an 80% chance of having nail psoriasis, too.

The same underlying causes as plaque psoriasis are at play here, too, revving up your skin cell production. Nails are considered part of the skin , which is why they are also affected by the disease.

Palmoplantar Psoriasis On Skin Of Color

Generally, plaque psoriasis on skin of color may not appear as pink. The plaques may be thicker and more silver-looking.

Some plaques may look more purple. A person is also likely to develop darkening or lightening of parts of the skin, which health experts call hyperpigmentation and hypopigmentation, respectively.

Palmoplantar psoriasis may be more common in white populations. However, among People of Color, the condition tends to impact people of India the most.

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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.

Psoriasis And Your Nails

Psoriasis can also affect your nails as they form. It could cause:

• Shallow or deep holes
• Discoloration

Corticosteroid creams or ointments and light therapy are also used to treat nail psoriasis. If these donââ¬â¢t get the job done, your doctor might suggest corticosteroid injections into your nail beds. Nail psoriasis can be complicated by fungal infections for whichà your doctor mayà prescribe anti-fungal agents.

Cosmetic repair is also an option. This can involve:

• Nail scraping and filing
• Artificial nails
• Surgical removal

To help prevent problems, trim your nails as short as possible, and wear gloves when you work with your hands. Read what you can do aboutà psoriasis on your hands, feet, nails,à and other tough spots.

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What Causes Scalp Psoriasis

Unlike dandruff, scalp psoriasis doesnt come and go with the weather, hormonal fluctuations, or changes in hair products. The cause is the same as other types of psoriasis: an overactive immune system, genetics, and triggers such as stress and certain medications. But in this case, the plaques that show up may only show up on your scalp.

Focus On Diet And Exercise

There are no studies showing that a particular food can exacerbate or benefit psoriasis, says Lebwohl. However, a general healthy diet, combined with exercise, can have great benefits, he says.

Thats because theres a strong correlation between obesity and psoriasis. Often, those who are obese experience more severe psoriasis symptoms. Conversely, weight loss can have a dramatically positive impact on people with psoriasis.

Exercise and diet that specifically lead to weight loss can help, Lebwohl notes. There are many studies that have shown that weight loss in combination with therapy improves psoriasis.

In addition, psoriasis medications have been shown to be more effective for those who have lost weight, he says.

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How Do You Get Rid Of Psoriasis On Your Feet

Treatment for psoriasis on the feet may involve a combination of topical medications, light therapy, and systemic drugs, such as immunosuppressants. Several lifestyle changes can also help prevent flare-ups of psoriasis over the long term.

A person can work with a doctor to determine the best course of treatment for them, which may depend on the specific type, location, and severity of psoriasis.

Medications That Treat Your Skin

Here are some common ways to treat psoriasis on the hands and feet and relieve your symptoms.

In addition to moisturizers, mild soaps, and soap substitutes, your doctor may recommend:

• Coal tar products, like creams, gels, or ointments, to slow skin growth and ease itchy, inflamed, or scaly skin
• Salicylic acid, a peeling agent that softens or reduces thick scales
• Corticosteroids, often creams and ointments

Combinations of these often work better than one treatment alone. Sometimes doctors suggest alternating or using topical corticosteroids with a type of vitamin D called calcipotriene. This medicine should not be used on the face, so be sure to wear gloves when applying to your hands and feet in order to avoid getting it on your face later.

Your doctor might have you use a corticosteroid under a type of dressing called hydrocolloid occlusion. This filmy layer bonds to the cream, helps keep skin moist, and can be worn for several days. Wetting your skin, rubbing on a corticosteroid cream and sealing it in with plastic wrap overnight also is helpful.

Tapinarof is a new steroid-free topical cream that is an aryl hydrocarbon receptor agonist approved to treat plaque psoriasis in adults. Applied once a day, it can be used on sensitive areas of the body and is safe for long-term use.

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What You Should Know About Erythrodermic Psoriasis

The rarest of all psoriasis types, erythrodermic psoriasis affects only 2% of those with psoriasis. This type causes redness from head to toe, as if your skin has been burned. Even worse, its possible that your skin could peel off in sheets.

As with the pustular type, erythrodermic psoriasis severely compromises the skins protective barrier, so swift medical attention is a must. You can also develop fever, chills, swollen, painful joints, and rapid heart rate.

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

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What Can I Do To Help My Feet

The most important action is to seek advice and help when you notice any changes in your foot, whatever they may be. You can talk to your GP or local pharmacist for advice. Some problems can be resolved simply. For issues that are more persistent you may be referred to a specialist, such as a dermatologist, rheumatologist, physiotherapist, surgeon or chiropodist/podiatrist.

For general foot care, personal hygiene is important, particularly in avoiding fungal and viral infections. Change shoes and socks regularly, avoid shoes which are ill-fitting or cause bad posture. If you are overweight, losing weight could relieve the pressure on your joints and improve your walking gait.

If you are diagnosed with psoriasis, develop a treatment regime that works for you often, applying treatment after a bath or shower, along with the use of an emollient, can make the process easier.

If you have nail involvement, keep nails trimmed and clean. If they are thick, try trimming them after soaking them in a bath or shower, as this makes them softer and easier to cut. Alternatively, seek an appointment with a chiropodist, which is often available via the NHS.

If you have psoriatic arthritis, it is important to rest inflamed joints. Sourcing footwear that supports the foot and helps to reduce the pressure on the inflamed areas can help, as can inner soles and orthotic supports. Once again, a chiropodist is best placed to advise you.

This article is adapted from The psoriatic foot leaflet.

What Are Hand Psoriasis Symptoms

Palmar psoriasis causes thick, scaly patches and often plaques on the palms and the soles of the feet. These scales may make the hands appear discolored due to inflammation and swollen.

In addition to the changes in the appearance of your hands, palmoplantar psoriasis can be itchy. Some people also experience pain and develop deep cracks called fissures in the scaly patches of their hands.

Because palmoplantar psoriasis isnt the only condition that can cause plaques and scales to the hands, it can be tricky for doctors to initially tell the difference between hand psoriasis and others, such as atopic dermatitis , Dr. Rosmarin explains.

You can even have both eczema and psoriasis on the hands, according to the National Psoriasis Foundation. In fact, about 63% of people with both psoriasis and eczema have hand involvement, according to a 2019 study published in the Journal of Dermatological Treatment.2

Some of the keys that can be helpful for us is if there is nail involvement, Dr. Rosmarin says. While both eczema and psoriasis can affect the nails with things like pitting, psoriasis is the skin disease that most frequently affects the nails, according to a 2017 study published in the journal Psoriasis.3

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How Do People Get A Second Type Of Psoriasis On Their Skin

While theres no way to predict who will develop a second type of psoriasis, some people may be more susceptible. For example, having severe psoriasis that isnt well controlled, stopping a strong medication too quickly, or getting strep throat may increase your risk.

The following explains how people who have plaque psoriasis, the most common type of psoriasis, can develop a second type of psoriasis on their skin.

Youll also find out how plaque psoriasis can turn into a different type of psoriasis.

Inverse psoriasis: Many people gain a lot of weight after getting plaque psoriasis. Researchers arent sure why this happens, but they have discovered that extra pounds can increase your risk of developing inverse psoriasis.

Inverse psoriasis only forms in areas where skin touches skin, such as the armpits, groin, or underneath the breasts. It causes smooth, bright-red patches of raw-feeling skin.

Guttate psoriasis: Some people with plaque psoriasis have developed guttate psoriasis after getting an infection, such as strep throat. Guttate psoriasis causes spots on the skin that are small, pink to salmon-colored, and scaly. These spots are often widespread, appearing on the torso, legs, and arms.

Erythrodermic psoriasis: Some people who have severe plaque psoriasis see their plaque psoriasis turn into erythrodermic psoriasis. This can happen when:

Different ways that psoriasis can affect the nails

Nail Psoriasis Fact Sheet

Learn more about the signs of nail psoriasis, treatment options and get tips for caring for your nails without making your nail psoriasis worse.

Betteridge, N., Boehncke, W. H., Bundy, C., Gossec, L., Gratacos, J., & Augustin, M. . Promoting patient-centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience. J Eur Acad Dermatol Venereol, 30, 576-585. doi:10.1111/jdv.13306

Jiaravuthisan, M. M., Sasseville, D., Vender, R. B., Murphy, F., & Muhn, C. Y. . Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol, 57, 1-27. doi:10.1016/j.jaad.2005.07.073

Merola, J. F., Li, T., Li, W. Q., Cho, E., & Qureshi, A. A. . Prevalence of psoriasis phenotypes among men and women in the USA. Clin Exp Dermatol, 41, 486-489. doi:10.1111/ced.12805

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How Can Gpp Be Treated

GPP is a serious condition, so it is essential that medical advice and treatment is sought immediately. People with GPP often need to stay in hospital to get more fluids into the body, stabilise temperature, and try to carefully bring the skin under control.

Treatment for GPP is usually cautious, to hopefully avoid aggravating the skin any further. Initially, affected areas will be treated with bland non-active treatment, for example emollient, compresses and/or oatmeal baths, to soothe the skin. Treatment may then move onto acitretin – an oral retinoid – or other systemic or biologic medications. PUVA may be used if appropriate. Antibiotics may also be prescribed, if an infection is present.

Von Zumbusch Pustular Psoriasis

von Zumbusch psoriasis, or acute generalized pustular psoriasis, is the most severe type of pustular psoriasis. Its very rare.

It begins with painful areas of red skin. Pustules form within hours and dry up in 1 or 2 days.

von Zumbusch psoriasis can recur in cycles, returning every few days or weeks. Its rare in children, but when it does occur the outcome is better than when it appears in adults. In children, the condition often improves without treatment.

Symptoms may include:

• dehydration

Immediate medical care is necessary for this condition. Over time, von Zumbusch psoriasis can cause weight loss and exhaustion.

Potential complications include hair and nail loss, secondary bacterial infection, and liver damage. If left untreated, it can lead to cardiorespiratory failure.

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Articles On Types Of Psoriasis

• Erythrodermic 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.