Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentCopingSummary
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Coping
Summary
Psoriasis of the hands and feet, known aspalmoplantar psoriasis, is an inflammatory autoimmune disorder that causes scaly, itchy skin patches on the palms and soles. Theseplaquescan crack open and bleed as you walk or perform manual tasks.
Palmoplantar psoriasis can occur on its own or in addition to psoriasis elsewhere on the body. It can have a significant impact on quality of life and is, unfortunately, more resistant to traditional remedies (although newerbiologic drugshave shown promise as effective palmoplantar psoriasis treatment).
Suthep Wongkhad / EyeEm / Getty Images
What Does Psoriasis on the Hands and Feet Look Like?
Palmoplantar psoriasis specifically affects the palms and soles. Even so, it manifests with the samesymptomsasplaque psoriasisanywhere else.
Psoriasis on the hands and feet may look like:
Other Symptoms
It may also cause:
Routine tasks like washing dishes can dry and inflame the skin. Working on your feet can also generate heat, friction, andinflammationthat can make the condition worse.
Variations and Co-Occurring Conditions
A variation of the disease, calledacrodermatitis continua of Hallopeau(ACH), causes pus-filled lesions on the palms, soles, fingers, or toes. It is a subtype ofpustular psoriasis.
Palmoplantar co-occurs withnail psoriasis(also known as psoriatic onchodystrophy) in more than 50% of cases. This can cause the nail plate to thicken, lift, and crumble or develop unsightly pits, ridges, and discoloration.
Similarly, around one-third of people with palmoplantar psoriasis will experience psoriasis on other parts of their bodies.
Impact on Quality of Life
Plantopalmar psoriasis accounts for between 3% and 4% of all psoriasis cases.The underpinning of the disease, however, remains the same as all other forms of psoriasis.
Psoriasis is an autoimmune disease in which theimmune systemwill suddenly target and attack normal skin cells, known askeratinocytes.
The inflammatory attack causes the skin cells to grow at a vastly accelerated rate. As the cells push to the surface of the skin faster than they can be shed, the outermost layer of skin (epidermis) will start to thicken and form plaques.
Triggers
Commontriggersfor psoriasis on the hands, feet, or any other part of the body include:
With palmoplantar psoriasis specifically, repetitive stress on the hands or feet—such as wearing rough work gloves or ill-fitting shoes—can trigger a phenomenon known as theKoebner response. This is in when plaques spontaneously develop along the line of a trauma.
The Koebner response is more commonly seen in manual laborers or people with bunions, corns, or blisters on their feet.
There is no single lab test or imaging study that can definitively diagnose psoriasis on the hands or feet. Although the physical symptoms and signs may be enough to diagnose the disease with a high degree of certainty, other causes need to be ruled out to ensure the correct diagnosis.
Healthcare providers will not only look for classic signs of the disease but also conditions that commonly accompany palmoplantar psoriasis or increase its risk.
Some things your healthcare provider will look for include:
If there is any doubt about the diagnosis, your healthcare provider may take a tissue sample via abiopsy. Under the microscope, psoriatic skin cells will appear compressed.
What Else Could It Be?
Adifferential diagnosisis a process used to rule out all other possible causes of your symptoms. Among the diseases commonly included in a differential diagnosis for palmoplantar psoriasis are:
How Do You Treat Palmoplantar Psoriasis?
Foot and hand and psoriasis cannot be cured, but it can be managed so that symptoms are less severe and flare-ups are less often.
While palmoplantar psoriasis can be harder to manage than psoriasis of the body, the options for palmoplantar psoriasis treatment are more or less the same. These include the avoidance of psoriasis triggers as well as topical, oral, or injected drugs to reduce the severity of your symptoms.
Mild-to-Moderate
Mild-to-moderate palmoplantar psoriasis may be treated with topical treatments, including:
A technique called occlusion may also be used. With this, the hands or feet are covered with plastic wrap, plastic gloves, or a plastic bag for several hours or overnight to improve absorption of the topical treatment.
Moderate-to-Severe
Moderate-to-severe palmoplantar psoriasis may require aggressive therapies that target inflammation in specific ways. The options include:
How to Cope
Psoriasis usually requires lifelongmanagement. Even beyondmedications, there are things you can do to prevent hand and foot psoriasis flares and better cope with treatment:
Palmoplantar psoriasis is an autoimmune disorder affecting the palms and soles, causing painful, itchy plaques that may crack and bleed. It is more treatment-resistant than other types of psoriasis, but newer options show promise. Symptoms include red, scaly patches, itching, and cracking, which can worsen with friction.
Diagnosis relies on physical symptoms and ruling out similar conditions like eczema. Treatments range from topical creams for mild cases to biologic drugs and phototherapy for severe cases. Lifestyle changes, such as moisturizing, avoiding hot water, and managing stress, help reduce flares.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Engin B, Askin O, Tuzun Y, et al.Palmoplantar psoriasis.Clin Dermatol. 2017 Jan-Feb;35(1):19-27. doi:10.1016/j.clindermatol.2016.09.004Smith MP, Ly K, Thibodeaux Q, Bhutani T, Liao W, Beck KM.Acrodermatitis continua of Hallopeau: clinical perspectives.Psoriasis (Auckl).2019;9:65–72. doi:10.2147/PTT.S180608Chung J, Duffin KC, Takeshita J, et al.Palmoplantar psoriasis is associated with greater impairment of health-related quality of life compared to moderate-to-severe plaque psoriasis.J Am Acad Dermatol. 2014 Oct;71(4):623–32. doi:10.1016/j.jaad.2014.04.063Broggi G, Failla M, Pealicelli A, Zanelli M, Caltabiano R.Palmoplantar psoriasis: a clinico-pathologic study on a series of 21 cases with emphasis on differential diagnosis.Diagnostics.2012;12(12):3071. doi:10.3390/diagnostics12123071Ayala-Fontánez N, Soler DC, McCormick TS.Current knowledge on psoriasis and autoimmune diseases.Psoriasis (Auckl). 2016;6:7‐32. doi:10.2147/PTT.S64950American Academy of Dermatologists Association.Psoriasis clinical guidelines.Piquero-Casals J, Morgado-Carrasco D, Granger C, Trullàs C, Jesús-Silva A, Krutmann J. Urea in Dermatology: A Review of its Emollient, Moisturizing, Keratolytic, Skin Barrier Enhancing and Antimicrobial Properties. Dermatol Ther (Heidelb). 2021 Dec;11(6):1905-1915. doi: 10.1007/s13555-021-00611-y. Epub 2021 Oct 1. PMID: 34596890; PMCID: PMC8611129.Food and Drug Administration.VTAMA (tapinarof) cream.Zito PM, Patel P, Mazzoni T. Acitretin. [Updated 2024 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519571/The American Academy of Dermatology Associateion.Psoriasis treatment: Cyclosporine.Psoriasis and Psoriatic Arthritis Alliance.Psoriasis and handwashing.National Psoriasis Foundation.Taking care of you skin in summer.Timotijevic ZS, Trajkovic G, Jankovic S, et alHow frequently does palmoplantar psoriasis affect the palms and/or soles? A systematic review and meta-analysis.Serbia Adv Dermatol Allergol. 2019;36(5):595–603. doi:10.5114/ada.2019.89508Additional ReadingHongal A, Rajashekhar N, Gejje S.Palmoplantar dermatoses - A clinical study of 300 cases.J Clin Diagn Res.2016;10(8):WC04-WC07. doi:10.7860/JCDR/2016/20818.8364
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Engin B, Askin O, Tuzun Y, et al.Palmoplantar psoriasis.Clin Dermatol. 2017 Jan-Feb;35(1):19-27. doi:10.1016/j.clindermatol.2016.09.004Smith MP, Ly K, Thibodeaux Q, Bhutani T, Liao W, Beck KM.Acrodermatitis continua of Hallopeau: clinical perspectives.Psoriasis (Auckl).2019;9:65–72. doi:10.2147/PTT.S180608Chung J, Duffin KC, Takeshita J, et al.Palmoplantar psoriasis is associated with greater impairment of health-related quality of life compared to moderate-to-severe plaque psoriasis.J Am Acad Dermatol. 2014 Oct;71(4):623–32. doi:10.1016/j.jaad.2014.04.063Broggi G, Failla M, Pealicelli A, Zanelli M, Caltabiano R.Palmoplantar psoriasis: a clinico-pathologic study on a series of 21 cases with emphasis on differential diagnosis.Diagnostics.2012;12(12):3071. doi:10.3390/diagnostics12123071Ayala-Fontánez N, Soler DC, McCormick TS.Current knowledge on psoriasis and autoimmune diseases.Psoriasis (Auckl). 2016;6:7‐32. doi:10.2147/PTT.S64950American Academy of Dermatologists Association.Psoriasis clinical guidelines.Piquero-Casals J, Morgado-Carrasco D, Granger C, Trullàs C, Jesús-Silva A, Krutmann J. Urea in Dermatology: A Review of its Emollient, Moisturizing, Keratolytic, Skin Barrier Enhancing and Antimicrobial Properties. Dermatol Ther (Heidelb). 2021 Dec;11(6):1905-1915. doi: 10.1007/s13555-021-00611-y. Epub 2021 Oct 1. PMID: 34596890; PMCID: PMC8611129.Food and Drug Administration.VTAMA (tapinarof) cream.Zito PM, Patel P, Mazzoni T. Acitretin. [Updated 2024 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519571/The American Academy of Dermatology Associateion.Psoriasis treatment: Cyclosporine.Psoriasis and Psoriatic Arthritis Alliance.Psoriasis and handwashing.National Psoriasis Foundation.Taking care of you skin in summer.Timotijevic ZS, Trajkovic G, Jankovic S, et alHow frequently does palmoplantar psoriasis affect the palms and/or soles? A systematic review and meta-analysis.Serbia Adv Dermatol Allergol. 2019;36(5):595–603. doi:10.5114/ada.2019.89508Additional ReadingHongal A, Rajashekhar N, Gejje S.Palmoplantar dermatoses - A clinical study of 300 cases.J Clin Diagn Res.2016;10(8):WC04-WC07. doi:10.7860/JCDR/2016/20818.8364
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Engin B, Askin O, Tuzun Y, et al.Palmoplantar psoriasis.Clin Dermatol. 2017 Jan-Feb;35(1):19-27. doi:10.1016/j.clindermatol.2016.09.004Smith MP, Ly K, Thibodeaux Q, Bhutani T, Liao W, Beck KM.Acrodermatitis continua of Hallopeau: clinical perspectives.Psoriasis (Auckl).2019;9:65–72. doi:10.2147/PTT.S180608Chung J, Duffin KC, Takeshita J, et al.Palmoplantar psoriasis is associated with greater impairment of health-related quality of life compared to moderate-to-severe plaque psoriasis.J Am Acad Dermatol. 2014 Oct;71(4):623–32. doi:10.1016/j.jaad.2014.04.063Broggi G, Failla M, Pealicelli A, Zanelli M, Caltabiano R.Palmoplantar psoriasis: a clinico-pathologic study on a series of 21 cases with emphasis on differential diagnosis.Diagnostics.2012;12(12):3071. doi:10.3390/diagnostics12123071Ayala-Fontánez N, Soler DC, McCormick TS.Current knowledge on psoriasis and autoimmune diseases.Psoriasis (Auckl). 2016;6:7‐32. doi:10.2147/PTT.S64950American Academy of Dermatologists Association.Psoriasis clinical guidelines.Piquero-Casals J, Morgado-Carrasco D, Granger C, Trullàs C, Jesús-Silva A, Krutmann J. Urea in Dermatology: A Review of its Emollient, Moisturizing, Keratolytic, Skin Barrier Enhancing and Antimicrobial Properties. Dermatol Ther (Heidelb). 2021 Dec;11(6):1905-1915. doi: 10.1007/s13555-021-00611-y. Epub 2021 Oct 1. PMID: 34596890; PMCID: PMC8611129.Food and Drug Administration.VTAMA (tapinarof) cream.Zito PM, Patel P, Mazzoni T. Acitretin. [Updated 2024 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519571/The American Academy of Dermatology Associateion.Psoriasis treatment: Cyclosporine.Psoriasis and Psoriatic Arthritis Alliance.Psoriasis and handwashing.National Psoriasis Foundation.Taking care of you skin in summer.Timotijevic ZS, Trajkovic G, Jankovic S, et alHow frequently does palmoplantar psoriasis affect the palms and/or soles? A systematic review and meta-analysis.Serbia Adv Dermatol Allergol. 2019;36(5):595–603. doi:10.5114/ada.2019.89508
Engin B, Askin O, Tuzun Y, et al.Palmoplantar psoriasis.Clin Dermatol. 2017 Jan-Feb;35(1):19-27. doi:10.1016/j.clindermatol.2016.09.004
Smith MP, Ly K, Thibodeaux Q, Bhutani T, Liao W, Beck KM.Acrodermatitis continua of Hallopeau: clinical perspectives.Psoriasis (Auckl).2019;9:65–72. doi:10.2147/PTT.S180608
Chung J, Duffin KC, Takeshita J, et al.Palmoplantar psoriasis is associated with greater impairment of health-related quality of life compared to moderate-to-severe plaque psoriasis.J Am Acad Dermatol. 2014 Oct;71(4):623–32. doi:10.1016/j.jaad.2014.04.063
Broggi G, Failla M, Pealicelli A, Zanelli M, Caltabiano R.Palmoplantar psoriasis: a clinico-pathologic study on a series of 21 cases with emphasis on differential diagnosis.Diagnostics.2012;12(12):3071. doi:10.3390/diagnostics12123071
Ayala-Fontánez N, Soler DC, McCormick TS.Current knowledge on psoriasis and autoimmune diseases.Psoriasis (Auckl). 2016;6:7‐32. doi:10.2147/PTT.S64950
American Academy of Dermatologists Association.Psoriasis clinical guidelines.
Piquero-Casals J, Morgado-Carrasco D, Granger C, Trullàs C, Jesús-Silva A, Krutmann J. Urea in Dermatology: A Review of its Emollient, Moisturizing, Keratolytic, Skin Barrier Enhancing and Antimicrobial Properties. Dermatol Ther (Heidelb). 2021 Dec;11(6):1905-1915. doi: 10.1007/s13555-021-00611-y. Epub 2021 Oct 1. PMID: 34596890; PMCID: PMC8611129.
Food and Drug Administration.VTAMA (tapinarof) cream.
Zito PM, Patel P, Mazzoni T. Acitretin. [Updated 2024 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519571/
The American Academy of Dermatology Associateion.Psoriasis treatment: Cyclosporine.
Psoriasis and Psoriatic Arthritis Alliance.Psoriasis and handwashing.
National Psoriasis Foundation.Taking care of you skin in summer.
Timotijevic ZS, Trajkovic G, Jankovic S, et alHow frequently does palmoplantar psoriasis affect the palms and/or soles? A systematic review and meta-analysis.Serbia Adv Dermatol Allergol. 2019;36(5):595–603. doi:10.5114/ada.2019.89508
Hongal A, Rajashekhar N, Gejje S.Palmoplantar dermatoses - A clinical study of 300 cases.J Clin Diagn Res.2016;10(8):WC04-WC07. doi:10.7860/JCDR/2016/20818.8364
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