Can you imagine cringing at the thought of giving a high-five?
If you have psoriasis on your hands, you know the feeling. This type of contact with another person can be both embarrassing and painful.
“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.
This 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.
There Are Four Types of Hand Psoriasis
This form of psoriasis appears only on the palms and/or the bottoms of the feet, and it is less than 5% of psoriasis cases, according to the Journal of the American Academy of Dermatology. This is the kind that makes those high-fives and handshakes really uncomfortable, and in some cases, the 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.”
This is sometimes referred to as “sausage” fingers, and it often involves painful swelling along your entire finger or toe, not just around one of the joints. It's 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.
This is the swelling of the entheses, or the connective tissue that joins ligaments and tendons to the bones in your hands. Enthesitis can also occur even if the skin on your hands has been clear. Because psoriasis is a systemic inflammatory disease, that inflammation can happen anywhere in your body. Your fingers may feel stiff and painful, but unlike dactylitis, you may not have visible swelling. Your rheumatologist or dermatologist may suggest an oral or injectable anti-inflammatory to relieve the ache.
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 percent to as high as 80 percent in those with psoriasis.
6 Ways to Cope With 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 stiffness and swelling are significant issues, 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. 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 Keobner 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 Maryland. (Check out these derm-approved picks.)
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 counselor, 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. (About time, right?!) Learn more about how psychodermatology can help, and to find a specialist in your area, click here.
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