7 Tips for Treating Psoriasis on the Hands

Plaque psoriasis is the most common form of the disease. It typically shows up on the scalp, knees, elbows, and lower back, but some people get plaque psoriasis on their hands, too.

Pustular psoriasis is characterized by white blisters of pus surrounded by red skin. When it appears on the palms of the hands and soles of the feet, it is known as palmoplantar pustulosis (PPP). This usually comes in cycles, with new outbreaks of pustules followed by intervals of inactivity, according to the National Psoriasis Foundation.

Knowing which kind of psoriasis you have can help you and your doctor come up with a customized treatment and care plan.

If You Smoke, Quit

With all types of psoriasis, flare-ups can be triggered, and smoking may be a pretty common trigger for PPP, in particular. In a small study published in the British Journal of Dermatology, almost 95 percent of patients with psoriasis of the hands and feet were former or current smokers.

Rhonda Klein, M.D., board-certified dermatologist at Modern Dermatology of Connecticut in Westport, notes that while smoking could make psoriasis worse, the habit may be so common in this group because stress can be so high—and people may turn to cigarettes to cope.

“It may, in fact, be the underlying stress that is the actual trigger,” explains Klein. “When we are stressed, our cortisol levels rise, which can trigger inflammation. Psoriasis is an inflammatory condition, and therefore this can cause a flare.”

Still, quitting smoking could help your psoriasis treatments work more effectively, say researchers. Consider talking to your doctor about smoking cessation programs that can help.

Protect Your Hands

All forms of psoriasis are made worse by trauma or friction to the skin, says Sandy Skotnicki, M.D., board-certified dermatologist at Bay Dermatology Centre in Toronto, Canada, and author of Beyond Soap. She recommends using hand protection, such as reusable non-latex rubber gloves for “wet work,” such as washing dishes, and cloth gloves for gardening and other manual work.

Choose the Right Hand Cream

Skotnicki also recommends washing hands with a gentle, pH-balanced cleanser and moisturizing with a reparative cream made specially for the hands after every wash. Suggested options include La Roche-Posay Cicaplast Soothing Repairing Balm and Bioderma Atoderm Hand and Nail Cream.

“Nobody wants to use greasy prescribed creams during the day,” says Skotnicki. “I often prescribe a non-greasy topical for the morning and a greasy, Vaseline-type one for nighttime, to increase compliance.” Consider asking your doctor to do the same. It just might motivate you to use your cream as prescribed instead of skipping applications.

Try a New Treatment

Sometimes, a treatment doesn’t work out, and you have to try something new. If you’ve been prescribed a corticosteroid treatment, and it isn’t doing the trick, Skotnicki recommends asking your dermatologist about special targeted oral drugs for hand psoriasis, such as alitretinoin (Toctino), a vitamin A derivative that belongs to a class of medications called retinoids.

Klein treats patients with hand psoriasis with a range of methods, including topicals like coal tar, salicylic acid, and corticosteroids as well as in-office phototherapy and biologic therapies. “Systemic medications like Otezla (apremilast), methotrexate or acitretin can clear many cases of palm and sole psoriasis within a few months,” she says.

Care for Flares

Our hands are the part of the body that comes into contact with the outside world the most. This means they encounter more environmental triggers than other parts of the body, says Klein.

Soothing a psoriasis flare as soon as it appears will help minimize its effects and avoid long-term scarring. “Wear cotton gloves to help your topical medications absorb and protect the compromised skin until it heals,” Klein says. She says alcohol-based hand sanitizer can dry out the skin and cause further irritation, so you may want to stick to washing your hands instead while flaring.

Manage Stress

Psoriasis on the hands can have an emotional impact, too, since these parts of the body are typically always on show. Misconceptions about psoriasis—like that it’s contagious or a result of poor hygiene—can make a difficult situation even harder, and you may feel self-conscious about your hands while you’re flaring.

This is where self-care comes into play. Whatever lowers your stress levels and makes you feel more relaxed, do it. That may be exercise, spending time in nature, yoga, deep breathing exercises, or an enjoyable activity like reading or painting.

Managing your stress in healthy ways may also keep you from reaching for a cigarette as a coping mechanism—or alcohol, which can also be a trigger.

Klein encourages her patients to talk with her about the emotional impact of psoriasis as well as the physical symptoms. In addition to a dermatologist, you may also want to see a mental health professional who can help you through any tough feelings.

“Psoriasis has a lot of emotional sensitivity attached to it and one of the reasons I love my job so much is helping patients manage their disease, so it doesn't stand in their way of enjoying life,” Klein says. “It's very important that we talk more about psoriasis and eradicate the misconceptions.”

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