5 Ways to Treat Psoriasis on the Feet
Our feet are involved in so many of our daily movements and activities—things we take for granted until psoriasis gets in the way.
“Psoriasis of the feet is not just a nuisance,” says Brian Toy, M.D., a board-certified dermatologist with Mission Hospital in California and clinical professor at the Keck School of Medicine at the University of Southern California. “It can be extremely painful.”
Thick plaques on the feet can make it difficult to walk, and large scales on the soles may snag on flooring. Plaques can crack and bleed, and blisters can fill with pus, says Toy. Any friction or pressure on the feet can exacerbate symptoms, making this type of psoriasis—called palmoplantar psoriasis—distressing. Plus, managing and treating psoriasis on your feet can be challenging because you use this part of your body so much.
About 40 percent of people who have plaque psoriasis get it on their feet, according to the National Psoriasis Foundation. Some people can also develop white or yellow pustules on the feet called pustular psoriasis.
While dealing with psoriasis on the feet can be distressing, a wide range of treatment options and at-home therapies can help your skin heal.
The first line of defense against psoriasis on the feet often involves topical medications, which are applied directly to the affected skin to reduce inflammation and irritation. “Often, we prescribe a cocktail comprising a potent topical corticosteroid and calcipotriene, a form of vitamin D,” says Ava Shamban, M.D., a board-certified dermatologist based in Los Angeles.
Toy prefers clobetasol propionate 0.05% foam due to its high amount of isopropyl myristate. “This allows the steroid to penetrate through the skin more effectively than a cream or ointment, which sits on the surface of the skin like an oil slick,” he explains.
Coal tar products, such as gels or ointments, help to slow cell proliferation and ease itchy, inflamed, or scaly skin. Shamban also recommends salicylic acid (an effective peeling agent) to soften or reduce thick scales, and low -dose retinoids to help slow the overproduction of cells.
Some topical treatments for foot psoriasis, such as salicylic acid 20% and urea 40%, are available over the counter. “These products, known as keratolytics, help slough the dead layers of skin off the soles and improve the appearance of the feet,” Toy says.
Another effective treatment for foot psoriasis is topical PUVA (psoralen and ultraviolet A light therapy), according to Toy. This involves soaking the patients’ feet in a solution of psoralen, then activating it with ultraviolet A light (UVA) emitted by a machine. PUVA works well for some people, but the downsides are that it can be expensive and inconvenient, involving two to three treatments per week for several months at the dermatologist’s office to achieve remission. Remission is when patients are clear of psoriasis for a period of time. Because psoriasis is a chronic condition, it may recur and require repeat treatments months later.
If topical treatments don’t improve the symptoms of foot psoriasis, your doctor may suggest oral systemic medications, which can reduce inflammation throughout the body and, in turn, reduce symptoms.
In some cases, the antimetabolite drug methotrexate can have good results. “This slows the enzymes that result in the overgrowth of skin cells in psoriasis,” Shamban explains. However, it comes with several possible side effects, including tiredness, chills, fever, nausea, stomach pain, hair loss, and tender gums. And women who are pregnant, breastfeeding, or planning to become pregnant shouldn’t take methotrexate.
Acitretin, an oral retinoid (a form of vitamin A) is highly effective for psoriasis on the feet, Toy says, but it’s not used in women of childbearing age because it causes birth defects. The common side effects of acitretin include chapped skin and lips, hair loss, dry mouth, mood and behavior changes, and joint pain.
Apremilast, a phosphodiesterase inhibitor, is a newer oral medication that may be helpful. The common side effects include nausea, vomiting, diarrhea, weight loss, and mood changes.
A biologic is a type of systemic medication that is administered by injection or infusion and works by altering the immune system. This may be prescribed for psoriasis on the feet if doctors consider the patient to have moderate to severe disease or if the condition is significantly affecting the person’s quality of life.
Most biologics can improve symptoms for some people with psoriasis on the feet, according to the National Psoriasis Foundation. In fact, a review published in AJMC suggests that several biologics were effective in treating palmoplantar psoriasis, but researchers said more research was needed.
Home Remedies and Care
In addition to prescribed medications or therapies, you can practice skincare at home to relieve the symptoms of psoriasis on your feet. Shamban recommends a warm oatmeal foot soak with Dead Sea salt or Epsom salts, twice daily, if possible. At night, use a petroleum jelly product and wrap your feet with plastic wrap to hold in the moisture, soften the scales, and prevent cracking and bleeding.
While it might be tempting to file or cut thick psoriatic scales on your feet, Toy strongly advises against this. “It can make the problem worse,” he warns. Known as the Koebner phenomenon, this is when new plaques form on previously unaffected skin due to trauma or injury. Try to treat your feet with care, particularly during a flare-up. Shamban recommends wearing socks made of natural fibers and loose footwear like slides or Birkenstocks, with soft padded bottoms.
“Foot psoriasis can be very difficult to treat,” Toy says. “If your condition doesn’t improve, see your dermatologist for a proper, personal treatment plan.”
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