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

How to Make the Most of Your Psoriasis Checkups

From everydayhealth.com

Your doctor’s time is precious — and so is yours. Take these steps to speak confidently with your dermatologist and better manage your psoriasis 

If you feel like doctor’s appointments are short, it’s not your imagination. Research shows the average length of a primary care visit is around 18 minutes — hardly enough time to address your health concerns in depth.

But when you’re managing a chronic condition like psoriasis, every minute counts. You want to make sure you have time to share and get all your questions answered. 

Unfortunately, people with psoriasis don’t always get equal face time with their doctors. Research shows that the amount of time dermatologists spend with psoriasis patients may fluctuate based on the individual’s racial and ethnic background. And the findings suggest Asian people with psoriasis receive significantly less time with dermatologists.

Howard Chang, a psoriasis patient advocate and long-time Everyday Health blogger based in California, isn’t surprised by these findings. The son of Chinese immigrants, Chang recalls when both of his parents were diagnosed with psoriasis in 2014. When seeing a dermatologist, “They wouldn't really engage too much,” he notes. “It’s a very cultural thing. Just listen to the doctor, and the doctor is the authority.” 

Language barriers may also be a factor if someone isn’t comfortable speaking English, Chang adds. A lack of communication can lead to worse health outcomes if your doctor doesn’t know how you really feel or how closely you’re following your prescribed treatment regimen. 

That’s why it’s important to take steps to make the most out of every minute you get with your dermatologist.

What to Expect at a Psoriasis Checkup

To maximize each psoriasis check-up, you need to know what to expect.

During each visit, your dermatologist will ask how much of an impact psoriasis has on your day-to-day quality of life. They’ll also ask whether you have any new or worsening symptoms, including joint pain, which can be due to psoriatic arthritis. 

Your dermatologist will likely examine all of your skin. “We’re looking at the psoriasis — not just at the distribution or how much is involved, but also how thick the individual plaques are,” says Marisa Garshick, MD, an assistant clinical professor of dermatology at Weill Cornell Medical Center and dermatologist at MDCS Dermatology in New York City. 

What’s also important is a head-to-toe exam to check for skin cancer, which you may be at higher risk for if you’ve undergone phototherapy for psoriasis. 

If you have ongoing psoriasis symptoms, you’ll also discuss whether you may benefit from a change in treatment. You may even get in-office treatments, such as cortisone injections, to help calm any active psoriasis flares. 

          Developing a good relationship with your dermatologist can help you stay on top of the condition. Adobe Stock

Strategies to Try at Your Next Psoriasis Checkup

Now that you know what to expect, use these steps to get the most out of your next doctor’s appointment for psoriasis:

1. Check in online. Many healthcare systems now offer an online check-in process that you can fill out a day or so before your appointment. This gives you the chance to make any necessary updates to your contact info, pharmacy details, and insurance information. You’ll also be able to review any copays or balances owed to your dermatologist. Filling out this information before your visit can help make your life easier once you get to the appointment. “That way, there are no surprises when you check in,” says Chang.
2. Write down what you want to get out of the visit. This might include asking for medication refills, going over new symptoms, or talking about new treatment options. Chang uses a checklist in the Notes app on his iPhone to keep a running list of questions and answers from his dermatologist visits. “As I go through the appointment, I’ll check things off,” he says. “And the doctor, she knows now about my list, so she’ll point at my phone and say, ‘Anything else?’” 
3. Bring a friend or family member. An extra set of eyes and ears can be a big help. Your loved one can help remember what questions you wanted to ask and what the doctor says, Dr. Garshick notes. If there’s a language barrier, it can be especially helpful to bring along someone who is fluent in English — or ask for an interpreter — to make sure you understand all of the information, she adds.
4. Arrive early. Even if you’ve completed the check-in process online, it can still be helpful to arrive 15 minutes early for your appointment. Having downtime beforehand can be extra beneficial if doctor’s visits tend to stress you out. “If they’re going to do a blood pressure check, it’s nice to get there a little early, so you’re calm by the time they take the measurement,” Chang says.
5. Tell your doctor about every medication you’re taking. That includes any that aren’t for psoriasis, as some treatments for other conditions can actually worsen psoriasis. “Beta-blockers (which are sometimes used for blood pressure or heart rate), some antimalarial medications, and coming off of steroids can all trigger psoriasis,” says Garshick. Also, tell your dermatologist if you’ve just had an infection or were recently on antibiotics, which can contribute to psoriasis.
6. Be honest about how you’re feeling. Your dermatologist can’t help you if they don’t know what’s going on — even if it doesn’t seem related to your skin. “Reflect on anything that feels new or different for you,” says Garshick. That includes whole-body symptoms, such as fatigue, or joint pain. “Your dermatologist may not be able to address all your symptoms, but they might be able to guide you on whether or not certain things are connected to psoriasis or not,” she notes.
7. Speak up if something isn’t working for you. “I used to be ashamed if I wasn’t following the doctor’s orders perfectly,” says Chang. “Let’s say I was supposed to apply an ointment twice a day, and I was doing it every other day instead. I didn’t want the dermatologist to be upset with me, so I might not tell her. But in the end, it’s your health. If you’re not able to follow instructions, there may be something else you can do.” So, speak up and be honest with your doctor. 
8. Get your to-dos in writing. Ask for a written summary of the visit, so you can confirm exactly what you’re supposed to do, including your treatment plan and when to schedule your next visit. “If you’re just learning about psoriasis medicines, ask for brochures,” Garshick says. You can also research medication options on the National Psoriasis Foundation (NPF) website, she adds.
9. Take advantage of the patient portal between visits. If you need time to process what your dermatologist says or to ask questions after the visit, you can often do so through your healthcare system’s online patient portal. “Sometimes, in the moment, you forget something you want to ask, or you feel like it’s hard to say something,” says Chang. Sending your doctor a message through the patient portal is a good way to follow up.
10. Follow your treatment plan. Chang has found that following his psoriasis treatment plan exactly as prescribed allows him to see if a specific treatment really works for him. It’s also helped strengthen his relationship with his dermatologist. “If something’s not working out, I can say, ‘Hey, I did this, and I’m thinking of trying that now,’” he says. “Your doctor is likely more willing to consider what you want when you’ve already built trust by doing what you’ve agreed to do before.”
11. Take time after your visit to think about what feels best to you. “Remember that psoriasis is a chronic condition. So find a doctor that you feel comfortable with, so you can establish a long-term relationship,” says Garshick. If you aren’t seeing results or you feel uncomfortable with your doctor, don’t be afraid to try someone else. “Not all dermatologists are specialized in certain kinds of psoriasis or are up on the latest medications,” says Chang. “If you can’t work with your doctor, or they don’t have the expertise you need, then you might need to make a change.” The NPF has a directory of doctors who specialize in treating psoriasis. 

For more tips on how to make the most of your check-up, download the NPF Appointment Prep Kit.

https://www.everydayhealth.com/psoriasis/how-to-make-the-most-of-your-psoriasis-checkups/

Steroid Creams for Psoriasis: What to Know

From healthline.com

Steroid creams, also called topical steroids or corticosteroids, can help treat psoriasis, but long-term use can cause side effects. Here’s what to know about using these creams safely.

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Topical steroids are anti-inflammatory drugs you apply directly to your skin. These medications are one common treatment for psoriasis, an autoimmune condition where you develop scaly patches, called plaques, across your skin.

Steroid creams can shrink these patches or even help them go away completely. However, these medications can cause side effects if you use them for an extended period, so it’s important to follow any instructions your primary care doctor or dermatologist provides.

Below, get the details on different types of steroid creams, how they work, and precautions to take while using them.

How they work

If you have psoriasis, your immune system gets confused and starts attacking your own skin. Antibodies flood the area to defend against the attack, and the surrounding tissue becomes inflamed. You may notice discoloured skin, swelling, pain, and tenderness.

Psoriasis also causes your skin to produce cells faster than the old ones can fall off, which is what creates the plaques of thick and flaking skin.

When you apply a steroid cream, the steroids sink into the layers of your skin and enter various cells.

Topical steroids help treat psoriasis by telling your cells to:

• stop making so many inflammatory chemicals
• make more anti-inflammatory chemicals
• slow down the growth of new skin cells

Because corticosteroids resemble the steroid hormones made by your adrenal glands, the cells accept their instructions as if they came from your own body.

That said, you’ll need to keep applying the cream to replenish the medication in your skin. As the steroids hold off the psoriasis process, the patch should gradually shrink, allowing your skin to heal.

Types of steroid creams

Topical steroids are organised into 7 classes, with class 7 being the mildest and class 1 the strongest. Here are examples of creams you might find in each level:

• Class 7 (mild): Hydrocortisone (Synacort, Mycort-HC, Cortaid)
• Class 6 (mild): Desonide (Desowen)
• Class 5 (medium): Betamethasone valerate (Betaderm)
• Class 4 (medium): Mometasone furoate (Elocon)
• Class 3 (strong): Triamcinolone acetonide (Triderm)
• Class 2 (strong): Fluocinonide (Lidex)
• Class 1 (ultra-strong): Clobetasol propionate (Cormax, Temovate)

The Food and Drug Administration (FDA) has only approved the weakest steroid cream, hydrocortisone, as an over-the-counter (OTC) medication. You’ll need a prescription for all other topical steroids.

If you have plaques on sensitive areas, like your face or groin, you’ll probably want to stick with the mild or medium steroid creams.

Stronger steroid creams are typically prescribed for chronic psoriasis that involves very thick plaques. While high-level creams are more powerful, they also pose a higher risk of side effects. Healthcare professionals tend to reserve them for psoriasis plaques that don’t respond to gentler treatment.

Side effects

Steroid creams can cause changes to your skin like:

• thinning
• easier bruising
• colour changes (for instance, your skin may appear lighter, darker, reddish, or purplish, depending on your natural skin tone)
• stretch marks
• steroid-induced rosacea
• acne

Your risk of side effects goes up if you use steroid cream:

• with a high potency
• over large surface areas
• for longer than 3 weeks

Can topical steroids cause adrenal fatigue?

You may have read that chronic corticosteroid use can suppress the amount of natural steroid hormones your body produces and lead to adrenal fatigue, which can cause:

• weakness
• low blood pressure
• lack of appetite

However, adrenal fatigue is mostly a concern for other forms of steroid medication, like injections. That’s because injected or oral steroids have a higher rate of systemic absorption, which means they affect your body overall.

Even high potency steroid creams only rarely affect your adrenal glands. Topical steroids — those absorbed through your skin — only have a minimal effect on your body overall.

How to use topical steroids

Each medication works a little differently, so it’s important to follow the label instructions for your specific cream. If you have a prescription medication, make sure to use the cream exactly as the prescribing clinician directed — and check with them if you have any questions.

That said, here are a few things to keep in mind when using steroid cream:

• Apply regularly: Depending on the cream, you may need to apply it one to four times a day. Try to put it on at roughly the same time each day.
• Start small: You only need enough cream to make a thin layer over the psoriasis plaque. Rub it in gently.
• Only cover the plaques: Your regular skin doesn’t need thinning as a thick plaque does, so avoid rubbing the cream into your healthy skin.
• Only wrap if your doctor tells you: Covering your psoriasis plaques with a bandage or cloth can help the cream soak in better. But they might also spread the cream to healthy skin, so you’ll want to check with your doctor before wrapping your skin.
• Check with your doctor if you don’t notice an improvement: With most prescription steroid creams, you should notice some improvement in about a week — but if your symptoms don’t improve within about 2 weeksTrusted Source, you may want to check in with your doctor. If you’re using an OTC cream, it may take a little longer to notice the results.

FYI

If you’ve used a steroid cream for a long time and want to stop, your doctor may taper you off the medication. This means they’ll lower your dose gradually to prevent your psoriasis from flaring up in response to the sudden absence of medication.

Other psoriasis treatments

Since steroid creams affect your immune system, they may not be the best option if you’re currently recovering from an infection or living with an immunodeficiency disorder.

Your primary care doctor or other healthcare professional may also recommend non-steroid psoriasis treatments if you live with certain endocrine disorders, like Cushing syndrome.

Other treatments for psoriasis include:

• Vitamin D analogues: topical oils and ointments made of synthetic vitamin D
• Tar soap: soap made from pine tree resins or coal by-products
• Salicylic acid: a chemical exfoliant found in OTC face washes and creams that can slough off dead skin cells
• Methotrexate: a tablet or injection that suppresses your immune response
• Cyclosporine: another immune suppressant you can take orally or via injection
• Retinoids: oral or topical medications made from vitamin A compounds
• Biologics: medications made from living organisms that can block proteins that cause inflammation
• Phototherapy: a skin treatment that uses controlled exposure to UV light
• Laser therapy: lasers that target small areas of skin to destroy unhealthy cells

Your doctor may recommend combining steroid creams with other approaches to develop a treatment program that’s right for your specific psoriasis symptoms.

The bottom line

Steroid creams are one of the most common topical treatments for psoriasis.

While they can have powerful anti-inflammatory effects, they may also cause acne and skin discoloration or thinning if you use them for a long time.

Following your doctor’s directions when using steroid creams to treat psoriasis can minimise your risk of side effects.

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