So, Levy wasn’t all that surprised when, in college, he was also diagnosed with psoriasis, an autoimmune disease with a strong genetic link. The worst flare-ups were on his scalp — “I think it would’ve been hard for people not to notice,” he says, referencing the flakes on his shirt — but he also developed psoriasis on his fingernails as well as his feet. While flare-ups anywhere on his body were problematic, Levy found that those involving his hands and feet had a unique impact.
What Plaque Psoriasis on Hands Looks Like
Plaque psoriasis is the most common psoriasis type, usually appearing on the elbows, knees, lower back, and scalp. But it can show up on any part of the body, including the hands and feet. This kind of psoriasis is characterized by thick, scaly patches of skin. “On white skin, you’ll see redness or salmon-pink patches. On darker skin, you may not see the red as much; instead, the skin can look hyperpigmented, appearing brown or purple in color, depending on skin type and skin tone,” explains Jeffrey Cohen, MD, assistant professor of dermatology and director of the psoriasis treatment program at Yale Medical School in New Haven, Connecticut. Although nails take up a relatively small amount of the body’s surface area, they can create major discomfort. Per Cohen: “The nails can thicken, lift up, or get little divots.” That’s what Levy experienced. “My fingernails became pitted, which I later learned is a warning sign for psoriatic arthritis,” he says. A study published in 2017 in Reumatologia found that almost 80 percent of people with psoriatic arthritis have nail symptoms.
Pustular Psoriasis Can Affect Palms and Soles
There are other rarer types of psoriasis that can affect the hands and feet. “Some people develop pinpoint-sized white bumps, or pustules, on the surface of the skin, which can appear on the palms of the hands or on the soles of the feet,” says Elisabeth Richard, MD, assistant professor of dermatology at the Johns Hopkins University School of Medicine in Baltimore. As to why psoriasis develops on the hands and feet, Dr. Richard suggests, “It’s possible that it has to do with a process known as Koebnerization, which links trauma such as banging or frequently rubbing an area to flare-ups.”
Psoriasis Involving the Hands and Feet Can Interfere With Everyday Life
Psoriasis flare-ups on the hands and feet can be hard to live with, for some obvious and not-so-obvious reasons. “Often, there’s intense itching — that can be extremely debilitating,” says Cohen. And because psoriasis can thicken the skin, a phenomenon known as hyperkeratosis, it’s easy for painful cuts or fissures (cracks) to develop, especially in cold weather. These symptoms can pose obstacles that make everyday life stressful. With hand psoriasis, “Activities like typing can become difficult,” according to Cohen. Levy had flare-ups on the knuckles of his toes, which were initially itchy and eventually became raw and painful. “After I walked for a while, I would really start to feel it,” he says.
Anxiety and Depression Due to Hand and Foot Symptoms May Take Hold
Psoriasis flare-ups can lead to embarrassment — and worse. A study published in 2021 in Frontiers in Medicine involving more than 1,500 people with psoriasis found that people with psoriasis were more likely to experience depression than those without the skin condition. And a recent meta-analysis of studies found that 34 percent of patients with psoriasis had symptoms of anxiety. When psoriasis appears in a place as obvious as the hands, it causes a lot of social stress. “My patients with psoriasis on their hands tell me all the time that people are reluctant to give them a handshake,” says Richard, who emphasizes that psoriasis is definitely not contagious. “But it’s tough to go about your life if you don’t want people to see your hands,” Cohen acknowledges.
Finding the Right Psoriasis Treatment Can Help
The first-line treatment for psoriasis on the hands and feet (and other areas of the body) is typically topical steroids alternated with topical anti-inflammatories. “There are some very new nonsteroidal topical treatments that have been recently approved by the U.S. Food Drug Administration (FDA). The nonsteroidal topicals don’t thin the skin like steroids can do,” says Richard. There is also a new nonsteroidal treatment in pill form, deucravacitinib (Sotyktu), which the FDA approved in September 2022 for moderate to severe psoriasis. “It works by blocking certain molecules that affect immune system signaling, helping to prevent inflammation,” explains Cohen. Other treatments include light therapy, which can be a good option when psoriasis is localized as opposed to all over the body. “Light therapy is a well-established treatment that’s been in use for over 40 years. It’s a nice drug-free alternative that works well for some people,” says Richard. Two more options for moderate to severe psoriasis are the chemotherapy drug methotrexate and a class of drugs known as biologics, which are either administered through injection or intravenously. These medications target underlying inflammation by suppressing the body’s immune response, but they can sometimes cause side effects. Patients and doctors need to work closely together to decide whether these medications are the right choice. “Usually, we reserve biologics for people with moderate and severe psoriasis, when anywhere from 7 to 10 percent of the body is affected,” says Richard. “But the hands and feet can be a special case since they are so essential to a person’s quality of life, so we’ll often go to the more aggressive treatments sooner.”
Trial and Error Is Often Part of the Process in Psoriasis Treatment
Psoriasis patients often find they need to try a number of different treatments before settling on the most effective option. “That’s particularly true for psoriasis on the hands and feet — it’s common for people to go through many medications that don’t work before they find one that does,” acknowledges Cohen. For Steven Levy, it took seven or eight years for him to find the right approach. He started with steroid creams: “For me, the impact wasn’t worth the amount of effort it took to apply them twice a day.” He then moved on to methotrexate and, finally, biologics. “I’d say my psoriasis is now 97 percent better — it’s amazing, and I barely feel the shot,” he says. “When I first got psoriasis, biologics were kind of the last resort, but it seems like there are so many safer options now.”
The Right Psoriasis Treatments Can Significantly Improve Your Quality of Life
The bottom line: It’s important to see a dermatologist for psoriasis and not to give up, even if the first few treatments don’t work for you. “One thing I’d like patients to understand is that we have a lot of good options for psoriasis, and they are expanding all the time,” says Cohen. “I’ve seen it with so many patients — we can drastically improve the quality of a person’s life.”
