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 characterised by the formation of erythematous scaly plaques that are well-defined and located on the palms and soles. The plaques can be isolated or in association with generalised plaque psoriasis. It is also possible to observe sterile pustulations. Unlike other parts of the body, on the hands and feet, the lesions of psoriasis are dry, thick, crack and can bleed. Regarding the histological characteristics of this form of psoriasis, several foci of parakeratosis are observed alternating with orthokeratosis and the presence of inflammatory cells.

Far from being merely an aesthetic concern, palmo-plantar psoriasis can be highly debilitating due to its location and the associated pain and bleeding that occur on the soles of the feet. Whether it affects the hands or feet, psoriasis can interfere with simple daily tasks such as shaking someone's hand or putting on shoes. Given that these parts of the body are frequently used, it is essential to understand the appropriate method for treating psoriasis of the hands and feet.

Treating psoriasis of the hands and feet can be challenging, 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 flake off. Therefore, skin hydration must be carried out regularly. Use hand creams and gentle moisturising 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 period of remission. 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 cases 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 medical 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 retinoid group, 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 adverse 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 malformations in the foetus.

• Methotrexate and Ciclosporin : Methotrexate has allowed for an observation of 60.55% total improvement in scaling, and with ciclosporin, 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 ciclosporin can cause hypertension and nephrotoxicity, limiting its long-term use. Furthermore, like acitretin, methotrexate is contraindicated in young women without effective contraception due to the risk of serious malformations in the foetus. Due to the higher number of contraindications, methotrexate and ciclosporin are 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).