Psoriasis on the hands and feet
Acute flares of psoriasis on the hands and feet need to be treated promptly and carefully. In some cases, flares are accompanied by cracking, blisters and swelling.
General treatments include the use of moisturizers, mild soaps and soap substitutes. Some patients have helped heal non-bleeding, superficial skin fissures by closing them up with "super glue," Elmer's Wonder Bond Glue or Dermaflex, a product by Zila Pharmaceuticals. Use glues sparingly to avoid contact with unaffected skin.
Traditional topical treatment of palm and sole psoriasis includes tar, salicylic acid and steroids. Combinations of these three agents may be superior to each one used individually.
When directed by a doctor, some topical medications may be used with occlusion. This intensifies the effect of the cream or ointment. Cotton or plastic gloves can be worn over creams or moisturizers on the hands. Socks, or special occlusive foot covers, can be used on the feet. An easy way to occlude the feet is by putting each foot in a plastic bag and then putting a sock on over the bag. Try occlusion while you sleep or for an hour or two before going to bed. Soaking the hands or feet in warm water can reduce swelling, and should be followed by an application of medications or moisturizers.
It may be necessary to find additional ways to reduce built-up layers of skin in order for medications and phototherapy to be effective. You might try soaking in warm water with oilated oatmeal powder or bath oil for 20 to 30 minutes, then gently rub the affected skin with a sponge to remove scales.
Dovonex can also be effective with psoriasis on the hands and feet, however, cotton gloves should be worn to prevent transfer of the medication to sensitive skin sites, such as the face or skin folds. A regimen alternating Dovonex and potent topical steroids may be beneficial.
Occlusion with Tazorac is not usually recommended but could be useful for palm/sole lesions. You may also want to alternate Tazorac with a topical steroid.
If topical medications do not work, your doctor may recommend PUVA, methotrexate, cyclosporine or Soriatane (also known by its generic name acitretin). PUVA involves the use of a light-sensitizing drug called psoralen, which can be taken orally or applied topically, combined with exposure to ultraviolet light A (UVA). Special palm/sole units are available to treat psoriasis on the hands and feet.
Systemic treatments taken by mouth or injection for severe palm and sole psoriasis may be beneficial. In this case, the benefits of treatment may outweigh the risk of side effects. Methotrexate can clear most cases of palm and sole psoriasis within four to six weeks. However, methotrexate has the potential for side effects to the liver, which require regular monitoring by a doctor. Cyclosporine is similarly effective for palm and sole psoriasis but has the potential for kidney side effects. Biologics may be effective for treating psoriasis on the palms and soles. As a class of drugs, biologics were studied for chronic plaque psoriasis; however, after approval, success in treating all forms of psoriasis has been reported.
For people with scaling plaques of the palms and soles, oral retinoids such as Soriatane will result in thinning of plaques over a period of days or weeks. Thinning the scale buildup on the palms or soles may increase the effectiveness of topical treatments.
Oral retinoids in lower dosages are generally well-tolerated. However, oral retinoids do cause birth defects and should not be taken by women planning a pregnancy within three years.
The risk of side effects from phototherapy are reduced by combining low doses of retinoids with ultraviolet light B (UVB) or PUVA. The combination of retinoids with PUVA is one of the most effective treatments available for palm and sole psoriasis.
Pustular psoriasis of the palms and soles
This form of psoriasis is characterized by white pustules (blisters of noninfectious pus) surrounded by red skin. The pus is not contagious. The lesions are most prominent on the palm toward the base of the thumb, the fleshy part of the palm toward the ring and little finger, and on the soles and sides of the heels. Often, the lesions are painful and disabling. Plaque psoriasis can appear elsewhere on the body at the same time.
Doctors usually prescribe topical treatments such as steroids and coal tar first. However, PUVA, retinoids and methotrexate may have to be used in order to clear this form. Antibiotics are occasionally prescribed with varying results. Oral retinoids, such as Soriatane, can be helpful for pustular psoriasis.
Updated October 2005
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