Psoriasis on hands: signs and when to see a doctor

This guide covers how psoriasis can look on the hands, why it can be tough to live with, what may set it off, and how to describe it to your doctor.

How psoriasis can look on the hands

Psoriasis on the palms (and the soles of the feet) is called palmoplantar psoriasis. It can appear in two main ways, according to the National Psoriasis Foundation (NPF):

• Plaque type. Skin is discolored, red, dry and thickened, often with deep, painful cracks (fissures). See Plaque psoriasis.
• Pustular type. Small pus-filled bumps appear on the palms and soles. The NPF says the pus is sterile, meaning it isn't caused by infection. See Pustular psoriasis.

The NHS also describes lots of small brown and yellow spots on the palms and soles.

Psoriasis can also affect the nails. The NHS says the surface of the nails can have dents and pits. If you have nail changes, mention them to your doctor, because a doctor usually checks the skin, scalp and nails together, according to NIAMS.

Why hands are a big deal

The NPF calls the hands and feet a "high-impact site". Psoriasis there can affect quality of life no matter how much skin is involved. Painful cracks can make holding things, typing or walking hard.

The NPF cites research in which people with palmoplantar psoriasis were almost twice as likely to report mobility problems, and almost 2.5 times as likely to report trouble with daily activities. If your hands hurt, tell your doctor.

What may set it off

The NPF lists these triggers for psoriasis on the palms and soles: stress, certain medicines, smoking, alcohol, skin injury, infections, weather changes and diet. The NHS adds that cuts, scratches and grazes can cause a flare-up.

Triggers differ from person to person, and some flares have no clear cause. Don't stop a medicine because you suspect it. Ask your doctor first.

Is it psoriasis or eczema?

Eczema is also common on the hands. The NHS lists the hands among the usual places for eczema, and NIAMS lists the hands as a common site for teens and adults. Both can leave skin dry, red or darker, itchy and cracked.

NIAMS describes eczema itch as often intense, and says people with eczema often also have asthma or allergies. Psoriasis can itch too, so you can't tell them apart this way. The NPF says a provider may look at how the skin looks, where it is and how itchy it is, and a skin biopsy (a small skin sample) may help tell psoriasis from other conditions.

Other skin conditions can also look like this, and only a doctor can tell which one it is. See Psoriasis vs eczema for the general differences.

Treatment options, at a high level

There is no cure for psoriasis, NIAMS says, but treatment aims to control symptoms. The NPF says hand and foot psoriasis is hard to treat, so you may need to try more than one option. The main groups are:

• topical treatments: creams and ointments, some from a pharmacy and some prescribed, steroid and non-steroid
• phototherapy: controlled ultraviolet light
• systemic treatments: tablets or injections that work throughout the body

The NPF says a provider may suggest covering a treated area with cotton or plastic gloves to help a cream work. Do this only if your provider tells you to. Talk to your doctor before starting, stopping or changing any treatment.

Everyday skin care

NIAMS's general advice for psoriasis is lukewarm water, mild soap with added oils, and a heavy moisturizer applied while the skin is still damp. Ask your doctor what suits your hands.

Joint pain: a reason to tell your doctor

Psoriasis can come with psoriatic arthritis, which affects the joints. The NPF says about 1 in 3 people with psoriasis also have it, usually after the skin symptoms start.

Signs the NPF lists include:

• pain, swelling and stiffness in joints, often worse in the morning or after rest
• red, discolored or warm joints
• "sausage-like" swelling of a whole finger or toe
• nail pitting, or the nail lifting from the nail bed

Early diagnosis and treatment can relieve symptoms and may help prevent permanent joint damage, the NPF says. If your fingers or hand joints hurt or swell, tell your doctor, even if your skin looks mild.

How to track hand psoriasis in a diary

A diary shows your doctor how your hands change from week to week. You might note:

• where: palms, fingers, nails, and any other part of the hands
• how it looks: dry, thick, red or darker, cracked, bumpy
• pain and itch, each from 0 to 10
• jobs and tasks that were hard: typing, cooking, buttoning, gripping
• possible triggers: a cut, stress, an illness, hand washing, cold weather
• joints: stiffness in the morning and how long it lasted
• what you used on your hands, as your doctor advised
• photos, if you wish, taken in the same light

Example entry: Thursday. Right palm: dry, thick, two cracks that sting. Pain 6/10, itch 3/10. Hard to hold a pen. Cold, windy day and a stressful week. Left ring finger a bit stiff for about 20 minutes this morning.

An app such as Velvi can keep these notes and photos in one private place for your appointment.

Questions to ask your doctor

• Is this psoriasis, eczema or something else? Do I need a skin sample?
• Which treatments suit my hands, and how will we know if they work?
• Should I cover my hands after applying a treatment?
• Could my nail changes or sore joints mean psoriatic arthritis?
• Should I see a dermatologist or a rheumatologist?
• When should I come back if it doesn't improve?