From self.com
How to know if you’ve (literally) got a problem on your hands
Imagine this scenario: Your future boss extends their hand for you to shake (you know, in a pre-pandemic world). But your hand psoriasis holds you back, and you’re worried your boss may not understand.
This is just one small example of how psoriasis on hands, also known as palmar psoriasis, can get in the way of your daily life, and make you think twice about doing “normal things” that people without psoriasis likely don’t think about at all. (No, psoriasis is not contagious, by the way.)
That’s why psoriasis, particularly when it’s present on visible areas of the skin, like the hands, can significantly affect you physically and mentally. Below, SELF talked to experts about how to identify hand psoriasis and what you can do about it—so you can feel a bit more comfortable in your own skin.
What is psoriasis and how can it affect the hands?
Psoriasis is a chronic, autoimmune skin condition that causes an overgrowth of inflamed, scaly, and sometimes itchy patches on the skin. Your body basically produces way too many new skin cells due to an immune system malfunction, which most commonly results in plaques, per the American Academy of Dermatology (AAD). While psoriasis tends to occur in places like the knees, elbows, and scalp, it can also appear on the hands. And when it does affect the hands, it’s traditionally more difficult to treat. This type is actually called palmoplantar psoriasis, because it only affects the hands and feet.
Psoriasis is uncomfortable, but when it appears in a highly visible place (not to mention the one area of the body you tend to use the most), the condition becomes a whole new issue. But you don’t have to go to Elsa-level lengths to conceal your hands with gloves. There are many psoriasis treatments available to help you find relief.
What are the types of psoriasis?
Palmoplantar psoriasis isn’t a common psoriasis type, only about 3% to 4% of people with psoriasis have it. However, about 40% of people with plaque psoriasis have symptoms on their hands and feet in addition to other areas of the body, according to the National Psoriasis Foundation. The different types of psoriasis include:
- Plaque: Plaque psoriasis is the most common psoriasis type. These usually appear as inflamed, patchy areas with silver, white, or grey scales above the pink, red, or purple-hued lesions. Plaques usually look the same on both sides of the body and commonly appear on the elbows, torso, knees, and scalp.
- Guttate: Guttate psoriasis causes small, scaly spots that can appear anywhere from brown to purple or red in colour, depending on your skin tone. They usually appear on the arms, trunk, and legs.
- Inverse: This psoriasis type appears in areas where skin rubs against skin. Think the armpits, under your boobs, inner thighs, and the groin. The skin may appear bright red or purplish depending on your skin tone, smooth, and almost raw in appearance.
- Palmoplantar: As we mentioned, palmoplantar psoriasis occurs when psoriasis affects only the palms of the hands and soles of the feet. This psoriasis type can appear patchy and scaly and may or may not have colour changes, like reddening of the skin, due to inflammation.
- Pustular: Pustular psoriasis usually occurs when you have another psoriasis form, and you develop pus-filled bumps on the skin. These bumps usually are present on the hands, feet, or both. Those with palmoplantar psoriasis can develop pustular palmoplantar psoriasis.
- Erythrodermic: Severe plaque psoriasis sufferers can sometimes have their condition develop into erythrodermic psoriasis. The psoriasis type causes severe symptoms that require immediate medical attention, including inflammation over most of the body, fever, chills, and dehydration. It can occur if your psoriasis isn’t well managed, or after a triggering event, such as getting a severe sunburn or experiencing an allergic reaction.
Can you have psoriasis on fingers or nails?
Psoriasis most commonly affects the palms of the hands. They may appear inflamed (pink, red, purple, or brown) with dry, thickened skin. The thick areas may have cracks or fissures. Sometimes, this appearance is similar to that of a fungal infection, like athlete’s foot, but on the hands.
About 60% of people who have psoriasis on their hands also experience changes to their fingernails. David 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 (discoloration that looks like you spilled oil under your nail)
- 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.
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 discoloured 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 isn’t 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 (also known as eczema,), 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.
“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.
If you have psoriasis that affects both the palms and soles of your feet, your doctor may also consider how your feet appear. With eczema, the arch of the foot (a non–weight bearing area) may have more lesions. This isn’t usually the case with psoriasis. “The pressure-bearing areas of the foot are usually worse in psoriasis,” Dr. Rosmarin says. This includes areas like the heel and the pad just below your toes.
What are the causes and triggers of hand psoriasis?
Doctors don’t know exactly what causes psoriasis on the hands. Instead of one specific cause, there’s likely a combination of genetic and environmental factors that play a role in its development. These include:
- Genetics, specifically variations on the human leukocyte antigen (HLA) 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. (Seriously, does stress make anything better?) 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.
On the physical stress side, some people experience psoriasis on their hands due to their occupation. Appropriately called occupational contact psoriasis, it causes flare-ups due to constant mechanical pressure on the skin from working with the hands as well as working with irritants. Drivers, cashiers, construction workers, dentists, and even pharmacists are at risk (due to frequent handling of bottle caps with a twisting motion), according to a 2020 study published in Occupational Dermatology. In this case, your job is causing the problem (but you probably knew that already).
It’s 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.
If you have both eczema and psoriasis on the hands, your doctor may recommend allergy testing to help identify what could worsen your symptoms. Avoiding these allergens may help to minimise psoriasis flare-ups.
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, it’s unfortunately not that simple if you potentially have psoriasis on your hands.
“While biopsies can help confirm psoriasis on other parts of the body, it’s not a good test when we are trying to differentiate it on the hands and feet,” Dr. Rosmarin explains. It’s really important to look at the symptoms, he says.
That’s not to say that a doctor may not recommend taking a biopsy if they want to try another diagnostic option. There aren’t 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-grey scales for those with palmar psoriasis or brown-orange dots for those with hand eczema.
What are hand psoriasis treatments?
You probably already know that psoriasis on the hands can be challenging to treat. While that can feel a little disheartening, know that there are still lots of options to try.
“There are some treatments, such as certain topical creams or ointments, that can help with both psoriasis and eczema,” Dr. Rosmarin says. “The immune system is too active in the skin, so we have medicines that can tell the immune system to calm down.”
Typically, the first-line treatment for psoriasis plaques on the hands is topical corticosteroids, which come in the form of anti-inflammatory creams, ointments, or gels. Sometimes, a doctor may recommend applying this with occlusion—this means wearing gloves or wrapping the hands, ideally to allow the medication to better penetrate. Other times, your dermatologist will recommend combining this medication with calcipotriene, an ointment that helps to slow skin cell growth.
Another topical application is acitretin. It’s a form of vitamin A (otherwise known as a retinoid) that can take three to six months of steady application to see results. (You shouldn’t use this treatment if you are thinking of getting pregnant or are pregnant, as oral retinoids have been linked to birth defects.)
Unfortunately, psoriasis plaques can sometimes be so thick that it’s difficult for the topical medications to fully penetrate the skin. When this is the case, you may need to turn to the second-line treatments. These usually involve systemic treatments (pills you take orally) or light therapy.
Light therapy involves exposing your affected skin to UVA or UVB rays. While this sounds super weird given that you probably haven’t gone outside without your best SPF in years, the light slows the overgrowth of skin that leads to psoriasis symptoms.
This is not by any means an excuse to hit the beach, footloose and sunscreen-free. Instead, doctors prescribe UVA or UVB therapy at very specific time frames and with special devices.
If your doctor doesn’t recommend the light therapy route, there are systemic medications you can take to help calm down your psoriasis symptoms. These are usually methotrexate or cyclosporine, which are both immunosuppressants. However, you would most likely only take these medications if your hand psoriasis symptoms are severe and don’t respond to any of the other listed treatments.
Your doctor may recommend biologics if the others medications don’t work or you can’t take them for some reason. These medications target specific parts of the immune system, specifically the ones known to cause psoriasis, and are given by injection or I.V. Your doctor can discuss these with you, including considerations for side effects.
The road to recovery and condition management for those with palmoplantar psoriasis isn’t a short one. Unfortunately, trial-and-error and time are often required to see a resolution. That’s why it’s important to find a doctor that you can trust.
Can you prevent psoriasis on hands?
It’s not always possible to prevent psoriasis on your hands. If you happen to know what triggers your psoriasis or makes it worse, avoiding those can help. This includes things like:
- Refraining from smoking
- Trying to keep your stress levels down
- Wearing protective equipment (like gloves) to avoid injury to your hands
- Refraining from exposing your skin to household or other chemicals (again, protective gloves may help)
However, if you try these and you still get hand psoriasis, know that you aren’t alone. There is a genetic component to the condition and other underlying immune system responses that you can’t necessarily control. Fortunately, there are lots of treatments you can try for hand psoriasis. While they do require patience and carefully following the suggested treatment plan, working closely with your dermatologist can help you figure out what works best for you.
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