How Does Psoriasis Affect the Hands?

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.

                                                                            Getty Images/Jatuphol Aroonsawasd

Where on the Hand Psoriasis Can Occur

According to the Cleveland Clinic, psoriasis on your hands can target your:

• Fingernails

• 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.

                                                                    Psoriasis on hands. Cureus/© 2021, P et al.

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

Can Psoriatic Arthritis Affect Your Toes?

From healthcentral.com

This chronic disease can cause pain, swelling, and damage to your distal interphalangeal joints. Here's what you can do about it 

If you’re living with psoriatic arthritis, you’re no stranger to joint pain, especially in the smaller joints in your body. Among its many pain points, psoriatic arthritis (PsA) can affect your digits, causing joint aches, swelling, and permanent damage. It often affects distal interphalangeal joints (otherwise known as your toes) and can be really uncomfortable, making walking and mobility in general a challenge.

But you don’t have to take psoriatic arthritis toe pain lying down. Learn what the experts say causes it—then find out what you can do to manage the pain.

Can Psoriatic Arthritis Affect the Toes?

Even though symptoms of PsA vary from person to person, many will observe the disease in their feet. According to the Archives of Medical Science, 50% to 70% of those with psoriatic arthritis experience foot abnormalities. 

                                                                           GettyImages/Doucefleur

For example, swelling of the toes (dactylitis) occurs in more than half (65%) of people with psoriatic disease. “Some of the first signs of psoriatic arthritis may appear in the feet,” says William Spielfogel, M.D., chief of podiatry at Northwell Lenox Hill Hospital in New York City. In addition to being one of the first signs, toe involvement may also indicate higher disease activity and more severe joint damage, according to the Journal of Rheumatology.

What Does Psoriatic Arthritis in the Toes Feel Like?

Psoriatic arthritis can attack your feet in a variety of ways, says Dr. Spielfogel. “The toes may have a sausage-like appearance,” he says, that leads to a deep pain when pressure or weight is applied to them.

“You may also experience pain in areas where tendons attach to bones, for example in the back of the heel and/or the bottom of the heel,” he explains. If your psoriatic arthritis has gone untreated, you may experience multiple swollen joints and even structural damage that can be seen on digital imaging.

What are the First Signs of Psoriatic Arthritis in Toes?

If you suspect your toes are being impacted by your psoriatic arthritis, there are several things to be on the lookout for, according to Dr. Spielfogel:

• Pain when you bend your toes

• Pitting of toenails

• Skin plaques

• Swollen digits

• Tendon attachment pain

• Thickening or lifting of toenails

“Issues that would cause one to suspect psoriatic arthritis would be pain at tendon attachments to bone,” Dr. Spielfogel says, along with swelling and pain. Nail involvement—typically in the form of pitting, thickening and lifting of your toenails—is also an indication of early disease.

“These signs in combination with shiny, scaling plaques on the skin would indicate a suspicion of psoriatic arthritis and should be referred to a rheumatologist for a full work up,” adds Dr. Spielfogel.

Swelling (Dactylitis) in Psoriatic Arthritis

Dactylitis describes swelling or inflammation of an entire finger or toe. This is sometimes referred to as sausage-digits. Dactylitis is about three times more likely to impact the toes than the fingers. Beyond being incredibly uncomfortable, dactylitis may also indicate more severe disease.

In a 2022 study, researchers found that those who had early onset of psoriatic arthritis (before age 40) were more likely to develop dactylitis, and dactylitis has been associated with more severe radiological damage. Among those with early onset, 45% had dactylitis compared to only 8% of those developing psoriatic arthritis after the age of 40.

Of equal importance, dactylitis may provide your doctor with a host of clues about the course of your psoriatic arthritis. “Dactylitis is a unique feature and helps define the spectrum of the disease,” says Elizabeth Schulman, M.D., a rheumatologist at Hospital for Special Surgery in New York City. “The presence of dactylitis certainly can help guide treatment.” Similarly, observing any changes in the toes can be an indication of disease advancement, which may help inform the treatment decisions you and your provider make.

“People tend to overlook the health of their feet in general and toes in particular—but toe involvement can raise a red flag, for sure, signifying sub-optimal treatment for psoriatic arthritis,” explains Dr. Schulman.

Hammer Toes in Psoriatic Arthritis

A hammer toe refers to a deformity in the shape of the toes. “The toe is typically contracted (bent) at the joint, thereby resembling a hammer,” Dr. Spielfogel explains. How does it happen? Each of us has a lining that covers our joints, known as synovium. This lining lubricates the joints. If the lining swells and becomes inflamed from your psoriatic arthritis, it can lead to joint destruction and weakened ligaments and tendons. These weaknesses can then cause joint deformities such as hammer toe. “Hammer toe can be associated with psoriatic arthritis, but not always a sign of it,” says Dr. Spielfogel.

How to Manage Psoriatic Arthritis Toe Symptoms

Toe involvement can be more than uncomfortable—it can make walking and standing next to impossible. Fortunately, there are things you can do to get back on your feet sooner than later. Start with these tips.

Follow Your Treatment Plan

“Working with your provider to get your disease under control is the first step in managing PsA toe involvement,” says Dr. Schulman. If you are waiting for a new treatment to work, non-steroidal anti-inflammatory drugs (NSAIDs) may help to reduce symptoms, she adds.

Do Joint-Friendly Exercises

Exercising with psoriatic arthritis toe involvement can seem beyond challenging. Looping in a physical therapist can be helpful in pain reduction, joint mobility, and providing exercise ideas that don’t involve extra stress on the toes (hydrotherapy as an example).

Consider Cold Therapy

The thought of immersing your foot into an ice bath may not sound like fun. It is also not for everyone, according to the journal Pain and Therapy. However, for a certain segment of the population, cold therapy (also known as cryotherapy) has demonstrated effectiveness with swelling reduction related to rheumatic diseases.

Wear Comfortable Shoes/Orthotics

“Switching to supportive footwear can help with the mechanical stress on the feet,” says Dr. Schulman. Give your toes a little extra breathing room by wearing, at least temporarily, a shoe with a wider toe box (possibly a man’s sneaker sized for a woman, for example). This may reduce further aggravation to the toes, which can compound their already inflamed state.

Keep Your Toenails Trimmed

If psoriatic arthritis has impacted your toes, nail care is paramount. Keeping your toenails as short as possible will help prevent them from rubbing or pressing against the end of your shoes, which will apply extra pressure to your toes, making your pain worse.

When to See a Doctor

Dr. Schulman says that if there is toe involvement, this is a time to let your provider know right away. “Not only does this indicate active psoriatic arthritis, but it can also indicate other conditions such as an infection,” she says. “If your psoriatic arthritis is impacting your toes, it is important to obtain a prompt evaluation from your provider.”

Bottom line? Psoriatic arthritis can attack multiple joints all over your body. But when it strikes your toes, the pain can literally be immobilising. The sooner you see your doctor and start on treatment, the faster you’ll be able to walk pain-free.

https://www.healthcentral.com/condition/psoriatic-arthritis/psoriatic-arthritis-toes