How to treat psoriasis of the hands and feet?

The psoriasis is a skin disease caused by inflammation. These thick and painful plaques usually appear on the scalp, face, elbows, and knees. As its name suggests, palmoplantar psoriasis primarily affects the palms of the hands and the soles of the feet. It accounts for 3 to 4% of all psoriasis cases and affects 2 to 3% of the global population.

It is characterized by the formation of erythematous scaly plaques that are well-defined and located on the palms and soles. The plaques can be isolated or associated with generalized plaque psoriasis. Sterile pustulation can also be observed. Unlike other parts of the body, on the hands and feet, psoriasis lesions are dry, thick, crack, and can bleed. Regarding the histological characteristics of this form of psoriasis, there are several foci of parakeratosis alternating with orthokeratosis and the presence of inflammatory cells.

Non-aesthetic in nature, palmo-plantar psoriasis can be highly debilitating due to its location and the pain and bleeding that occur on the soles of the feet. Whether it's on the hands or feet, psoriasis can interfere with simple daily tasks such as shaking someone's hand or putting on shoes. As these parts of the body are frequently used, it is essential to know the appropriate method for treating psoriasis of the hands and feet.

Treating psoriasis of the hands and feet is delicate, as the hands are frequently used for touch and are often washed. The feet, on the other hand, are commonly enclosed in shoes. However, it is possible to adopt certain daily habits to soothe palmoplantar psoriasis.

• Use gentle cleansing care products.

  To avoid further damaging the skin, it is recommended to use gentle cleansing care with a neutral pH for the hands and feet. If possible, avoid care products containing soap or fragrance, which can irritate the skin.

• Hydrating one's skin.

  The red patches dry out quickly and start to peel. Therefore, skin hydration must be performed regularly. Use hand creams and gentle moisturizing treatments for the skin.

• Avoid direct contact of detergents with the hands.

  Detergents have a basic pH that tends to increase the skin's pH (which is typically acidic), causing irritation and sensitivity. We advise wearing gloves when using these types of products.

Psoriasis cannot be permanently cured. Indeed, this disease appears spontaneously and disappears with a remission period. Psoriasis can manifest at any age, affecting both men and women. Treatments have been designed to treat and soothe psoriasis of the hands and feet.

• The corticosteroids: these are anti-inflammatory agents that have demonstrated efficacy in reducing inflammation in the case of palmoplantar psoriasis. They inhibit the transcription factor NF-kB by activating the transcription of the IkB gene, thereby conferring anti-inflammatory effects. Corticosteroids are available in the form of ointment, lotion, or cream. These medications require a prescription. If they do not work, it is recommended to contact a dermatologist to seek other solutions.

• The retinoids : Acitretin, a derivative of Vitamin A from the group of retinoids, has shown an efficacy of 48% in patients suffering from palmoplantar psoriasis. Its effect on psoriasis plaques appears after six to eight weeks. Their main side effect is that they can cause skin dryness and mucous membrane dryness. Generally, they are strictly contraindicated in young women without effective contraception due to the risk of serious fetal malformations.

• The Methotrexate and Cyclosporine : Methotrexate has allowed for an observed 60.55% total improvement in scaling, and with cyclosporine, a 50% reduction in the severity of the affected area was noted. The most common side effects with methotrexate are related to discomfort and disruption of liver function, while cyclosporine can cause hypertension and nephrotoxicity, limiting its long-term use. Moreover, like acitretin, methotrexate is contraindicated in young women without effective contraception due to the risk of serious fetal malformations. Due to the higher number of contraindications, methotrexate and cyclosporine are considered second-line treatments for palmoplantar psoriasis.

• RAPOSO I. & al. Palmoplantar psoriasis and palmoplantar pustulosis: Current treatment and future prospects. American Journal of Clinical Dermatology (2016).

• Psoriasis palmo-plantaire. Association France Psoriasis (2022).