From healthcentral.com
Learn the ways this chronic skin condition can cause rashes and lesions on your skin, plus the best ways to treat it
Most people think nothing of giving a high-five, but if you have psoriasis on your hands, you likely cringe just thinking about it. This type of contact with another person can be painful and sometimes embarrassing.
“Patches of psoriasis affecting the thick skin of the palms tends to crack, bleed, and cause painful fissures,” says Joel Gelfand, M.D., a professor of dermatology and epidemiology at the University of Pennsylvania in Philadelphia.
Let’s take a closer look at exactly how your hands can be affected by psoriasis, where on the hands psoriasis generally appears, and what you can do to treat it.
Where on the Hand Psoriasis Can Occur
According to the Cleveland Clinic, psoriasis on your hands can target your:
Fingers
Nails
Palms
Skin on top of the hand
Webbing between fingers
Wrists
Appearance of Hand Psoriasis
Psoriasis can occur from your wrist to your fingernails. Psoriasis on the hands often varies from predominantly pustular lesions to thick hyperkeratotic plaques, according to the journal Dermatologic Therapy. Like elsewhere on the body, psoriasis on the hands can appear as itchy, scaling, and reddened skin plaques.
Psoriasis on the nails can cause multiple irregularities of the nails including pitting, crumbling, thickening, discoloration, white or reddish spots, and separation of the nail from the nail bed. Though sometimes mistaken for nail fungus, nail psoriasis looks a little different.
Lesions and plaques caused by psoriasis can be so disabling that doing anything with your hands during a flare can feel impossible. Plus, it’s awkward to explain to a curious outsider what’s going on with your skin. If you have hand psoriasis (or think you might), here’s what’s going on and how you can keep it from disrupting your life.
Symptoms of Hand Psoriasis
While symptoms can vary from one person to the next, these are some of the tell-tale signs of psoriasis, based on which part of your hand it occurs on.
Palms and Fingers
According to the National Psoriasis Foundation, when you have psoriasis on your palms and fingers you may experience red/discoloured, dry, and thickened skin, as well as deep cracks on the skin. You may also have limited movement with your hands including grip strength or be limited in your ability to shake hands. That’s why when psoriasis strikes the hands, it is known to have an outsize effect.
Nails
According to a study published in the Journal of the American Academy of Dermatology, the most common features of nail psoriasis is onycholysis (nail plate separating from the nailbed) and nail plate pitting. You may also notice nail discoloration, especially if the nail has lifted from the nailbed. If the psoriasis that is attacking your nails goes untreated, it can result in a loss of the affected nails.
Prevalence of Hand Psoriasis
The prevalence of psoriasis varies around the world with about 3% of the U.S. population living with the condition. Out of those with psoriasis anywhere on their body, about 1 in 5 have psoriasis on the hands (and interestingly, about the same percentage have psoriasis on their feet).
Nail psoriasis is much more common with about half of the people with psoriasis having it on their nails. Across a lifetime, almost everyone (90%) of those with psoriasis will experience nail psoriasis, according to the National Psoriasis Foundation.
Causes of Hand Psoriasis
Psoriasis can show up anywhere on the body. Whether it is on your hands, feet, or scalp, the root cause of psoriasis is an overactive immune system. That overactive immune system may trigger a psoriasis flare due to one of these factors:
Environment
Genetics
Lifestyle (such as smoking)
Stress
Skin injury
Illness such as strep throat
Cold weather/decreased sunlight
Types of Hand Psoriasis
While colloquially people describe skin plaques and pain in this area as hand psoriasis, technically there are several subtypes of the chronic skin disease, depending specific symptoms and where exactly on your hands it appears. Types of hand psoriasis include:
Palmoplantar Psoriasis
This form of psoriasis appears only on the palms and/or the bottoms of the feet, and accounts for less than 5% of psoriasis cases, according to the Journal of the American Academy of Dermatology. Palmoplantar psoriasis can be extremely pain, making those high-fives and handshakes really uncomfortable. In some cases, symptoms can seriously disrupt your life. In at least one study, people with palmoplantar psoriasis were significantly more likely to have problems with mobility, self-care, and other everyday activities.
Treatment for palmoplantar psoriasis can be tricky. The condition is likely to lead to secondary fungal infections and people sometimes have allergic reactions to the topical medications they’re using for treatment. Those with palmoplantar psoriasis also tend to be hypersensitive to touch.
“Making matters even more difficult is that palmoplantar psoriasis is often resistant to treatment,” Dr. Gelfand says. “Current treatments, even our newest biologics, often have limited benefit for psoriasis of the palms.”
Dactylitis
Dactylitis is sometimes referred to as “sausage” fingers. Dactylitis is linked to psoriatic arthritis and most frequently appears in those whose psoriasis is advancing into psoriatic arthritis.
Dactylitis often involves painful swelling along your entire finger or toe, not just around one of the joints. It can be one of the first signs of psoriatic arthritis—even if you do not have psoriasis on your hands. Anti-inflammatory drugs, either over-the-counter or prescription, such as non-steroidal anti-inflammatory drugs (NSAIDs), may provide some relief. If your fingers start to swell, let your doctor know as soon as possible because early treatment can improve later outcomes.
Enthesitis
Enthesitis typically occurs in people whose psoriasis has evolved into psoriatic arthritis. Enthesitis the swelling of the entheses, or the connective tissue that joins ligaments and tendons to the bones in your hands. Your fingers may feel stiff and painful, but unlike dactylitis, you may not have visible swelling. Your dermatologist may suggest an oral or injectable anti-inflammatory to relieve the ache.
Nail Disease
Psoriasis causes your skin cells to reproduce much more quickly than they should thanks to an overactive immune system. Since your nails are part of the skin, psoriasis can develop under the cuticle and wreak havoc on the growth and health of your nails. As a result, you may see pitting, vertical ridges, discoloration, and separation from the nail bed. Estimates of nail psoriasis range from about 50% to as high as 80% in those with psoriasis.
Treatment of Hand Psoriasis
The treatments used for hand psoriasis are the same used for other forms of plaque psoriasis. There is no single best approach: Which treatment your doctor recommends will depend on a variety of factors such as how severe your psoriasis on your hands is, how long you have had psoriatic disease, and what other treatments you have already tried. Some of the more common treatments include:
Topicals
Topical medications are applied directly to the skin. They come in different forms such as lotions, tars, and bath solutions. There are helpful topical medications available over-the-counter without a doctor’s prescription. Some of the topicals that are now available are natural products made for sensitive skin.
The National Psoriasis Foundation keeps a list of products that are intended to be non-irritating for people with psoriasis. Your doctor may also prescribe a stronger topical to help bring your symptoms under control.
Phototherapy
Phototherapy, or light therapy for psoriasis, involves holding your hands under an ultraviolet light source on a regular basis. Ultraviolet light from the sun or an artificial light has a profound immunosuppressive effect. There are few side effects of phototherapy which is one explanation of why it has been around so long. Your dermatologist will have a medical UV light designed with a wavelength to best treat psoriasis.
Oral Treatments
For more advanced cases of psoriasis, your doctor may prescribe a systemic medication to be taken as a pill. Instead of acting locally on just your hands, some of the newer oral treatments can selectively target molecules inside of your immune cells to help reduce inflammation at the source—think of it as treating your psoriasis more upstream. If you are also living with psoriatic arthritis (PsA), an oral treatment may be prescribed that can treat your psoriasis and PsA simultaneously.
Biologics
Biologics are delivered by injection or infusion and target a specific part of your immune system, depending on which biologic you are prescribed. Studies have indicated that biologics can successfully manage previously difficult to treat psoriasis, such as on the hands and nails, according to the Journal of Clinical Medicine. The cost of biologic treatment can be challenging, even with health insurance. If you are unable to afford the medicine you are prescribed, talk to your doctor. There are a variety of programs designed to help meet the financial needs associated with biologic treatment.
How to Manage Hand Psoriasis
While there’s no cure for psoriasis, there are some things that you can do to ease symptoms that affect your hands.
See Your Dermatologist
Even if you have psoriasis on other parts of your body, you want to make sure that your new hand outbreak is indeed psoriasis and not another condition. According to the American Academy of Dermatology, dry and itchy skin can be caused by a number of conditions, including eczema. It’s not only difficult to tell the difference between the two (especially in kids), but you can have both at the same time. Similarly, if your finger joints are suddenly sore, you will need to rule out overuse, psoriatic arthritis, rheumatoid arthritis, osteoarthritis, or a virus such as Lyme disease.
Work With an Occupational Therapist
If you are dealing with psoriatic arthritis along with psoriasis, stiffness and swelling can be significant issues and you may benefit from working with an occupational therapist. “Many occupational therapists specialize in hand therapy and provide a variety of treatment options to assist with hand discomfort,” says Aleksandra Radjen, Ph.D., a physical therapist at the Cleveland Clinic in Ohio. What’s more, they help you improve the use of your hands and maintain the skills you need to live your everyday life.
Stay on Top of Your Overall Treatment Plan
By treating your psoriasis aggressively, you can help lessen its impact on your body overall. So take your meds regularly and on time, keep your body moving, and try to stick to a plant-based diet.
Protect Your Hands
Preventing hand injuries is extra important if you have psoriasis. Wear gloves or other protective gear whenever possible, including when you’re doing everyday chores like washing dishes or weeding the garden. New lesions can develop from a cut, bruise, or burn, a tendency known as the Koebner phenomenon (named after the dermatologist who discovered it, Heinrich Koebner).
Practice Good Nail Care
They need to be protected just as much as your skin: Use tools instead of your fingernails to open packaging; keep them short to prevent ripping; and avoid the harsh chemicals that can be found in some nail polishes and polish removers, which can weaken your nails even further. And don’t forget the moisturizer.
“Moisturize them every day with an emollient cream or ointment,” says Tamy Buckel, M.D., a dermatologist in Chestertown, MD.
Talk to a Mental Health Pro
If you feel self-conscious, embarrassed, or if your hand psoriasis is preventing you from doing the things you enjoy, it may be time to talk to someone about it. A counsellor, therapist, or even a psychodermatologist can be a great addition to your care team.
Never heard of a psychodermatologist? That’s probably because it’s a new subspecialty of dermatology and psychiatry, and it was created because healthcare professionals who recognized that having a skin condition can cause stress and anxiety.
Bottom line? Dealing with daily pain—whether it’s your hands, feet, or anywhere else on your body—is exhausting. If you have hand psoriasis, you do not need to go at this alone. Seek out the advice of dermatologist, who can guide you toward treatments and lifestyle changes to make your world a little easier.
https://www.healthcentral.com/condition/psoriasis/psoriasis-on-hands
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