You Can Get Psoriasis on Your Hands — Here’s What It Looks Like

You may notice symptoms of psoriasis on the palms of your hands. There are two possible causes for this:

Palmoplantar psoriasis

Palmoplantar psoriasis affects the skin on the palms of your hands and the soles of your feet. This potentially debilitating condition occurs in 12% to 16% of people with psoriasis.

Palmoplantar psoriasis can cause these symptoms:

• dry, scaly, and thickened skin (plaques)
• discolored patches of skin that look red, pink, yellow, or gray, based on skin tone
• impairment of hand function
• itching
• deep splits or cracks in skin (fissures)

Palmoplantar pustulosis

Palmoplantar pustulosis is a rare autoimmune condition. Some researchers believe it’s a form of pustular psoriasis, but it has features that aren’t usually present in psoriasis, so most scientists now consider it a separate condition.

Still, palmoplantar pustulosis and psoriasis seem to occur frequently together. Up to 25% of people with palmoplantar pustulosis also have chronic plaque psoriasis.

Palmoplantar pustulosis affects 0.01% to 0.05% of the population and is most likely to affect people assigned female at birth who smoke cigarettes.

Symptoms of palmoplantar pustulosis include:

• large yellow or white pustules (blisters) that burst open or darken as they dry out
• fissures, cracks, and scaly plaques
• pain
• burning sensation

Palmoplantar pustulosis can also cause changes to your nails.

Plaque psoriasis on the backs of hands can cause large skin lesions and scaly plaques that are painful and itchy. It can also significantly diminish your hand function.

Plaque color may vary based on skin tone. On light-colored skin, psoriasis on the backs of your hands may look red or pink with silvery-white scales. On darker skin tones, psoriasis may look purple or brown, with gray scales.

A 2017 study linked psoriasis on the backs of hands to feelings of stigmatization and lower quality of life. These effects were most common in people assigned female at birth.

Plaque psoriasis can cause raised, thickened plaques to form on your fingers and knuckles. When psoriasis affects this area of your hands, it can cause itching, swelling, and pain. It can also reduce your dexterity, making it hard to do regular tasks, like opening a jar or typing on a computer.

People with psoriatic arthritis may also have dactylitis (sausage fingers). This condition features extreme swelling and inflammation.

Around 90% of people with psoriasis will get nail psoriasis during their lifetime.

Nail psoriasis is sometimes a sign of psoriatic arthritis.

Psoriasis on your nails may affect some or all of your fingernails. It may also affect toenails, although this is less common. You may see its effects on:

• the nail bed (area of soft skin under each nail)
• the nail matrix (bottom of the nail where growth originates)
• the nail itself

Symptoms include:

• formation of shallow or deep holes in the nails (pitting)
• yellow or brown discoloration of the nail
• deformed nail shape
• significant increase in nail thickness
• separation of the nail from the nail bed (onycholysis)

A healthcare professional may recommend over-the-counter (OTC) or prescription treatments. Their recommendation may depend on which area of your hand psoriasis affects.

In many cases, you may need to use more than one type of treatment. Together with a healthcare professional, you may need to take a trial-and-error approach to treatment until you arrive at what works best for you.

OTC topical creams

Topical creams are creams that you apply directly to the affected areas of your skin. You can use OTC topical creams without needing a prescription. You may have to experiment with topicals to figure out which works best for you.

Many topical creams for psoriasis contain salicylic acid or coal tar.

Salicylic acid is a peeling agent that helps soften and shed plaque scales. Coal tar slows skin cell growth and reduces itching, scaling, and inflammation. Both of these ingredients are Food and Drug Administration (FDA) approved to treat psoriasis.

Some topical creams work specifically to reduce itchy skin and inflammation. They include ingredients such as:

• calamine lotion
• camphor
• hydrocortisone
• menthol
• benzocaine
• diphenhydramine hydrochloride

The National Psoriasis Foundation gives its Seal of Recognition to some OTC products that are nonirritating and safe to use. You can look for the seal on product packaging or look up a particular brand here.

Make sure to check the expiration date before you buy.

Prescription topicals

If OTC creams or lotions aren’t effective, a clinician may prescribe stronger versions or different types. You may use these alone or together with other treatments.

Prescribed topical creams and preparations include:

• Anthralin (aka dithranol): This medication can slow down the production of new skin cells.
• Topical calcineurin inhibitors (TCIs): A clinician may prescribe TCIs such as tacrolimus and pimecrolimus off label to treat psoriasis. These immunosuppressants reduce inflammation and relieve skin irritation.
• Synthetic vitamin D analog: Vitamin D analogs such as calcitriol can flatten plaques and slow down skin cell production.
• Corticosteroids: Prescribed steroids are stronger than their OTC counterparts.
• Tapinarof (Vtama): This newly approved nonsteroidal cream works by reducing inflammation.

Light therapy (phototherapy)

Light therapy is also known as phototherapy. It uses ultraviolet (UV) B light to slow the growth of skin cells. This helps to eliminate psoriasis plaques and other symptoms.

If a clinician recommends light therapy, they may schedule ongoing appointments for you in their office. They may also give you a prescription for a light therapy machine to use at home.

Other prescription medications

If you have moderate to severe psoriasis in multiple areas, a healthcare professional may recommend systemic medications that treat psoriasis throughout your entire body. You can take these by mouth, by injection, or intravenously (IV). These options include biologics, such as adalimumab (Humira).

For nail psoriasis, a clinician may prescribe intralesional steroids. This involves an injection into each affected nail.

Moisturizers

Treating hand psoriasis at home starts with keeping the affected areas moisturized. Topical emollients are creams that soften your skin by hydrating it and eliminating scales. Topical emollients may be especially helpful if you use anti-itch treatments that dry out the skin.

To increase the effectiveness of moisturizers, a healthcare professional may recommend using an occlusive dressing or covering, such as plastic wrap on top.

Sun exposure

It’s important to protect your skin from the sun. However, sun exposure in small doses (10 to 15 minutes) can provide helpful UVB light. Just be careful not to burn your skin and to moisturize it afterward. Don’t use tanning beds for this purpose.

It’s best to avoid the sun during hours of peak UV radiation. This typically occurs between 9 a.m. and 3 p.m. during standard time and 10 a.m. and 4 p.m. during daylight saving time.

Avoid irritants and triggers

Try to avoid or eliminate using products that contain harsh chemicals. These can dry or irritate your hands, making psoriasis worse. Household cleaners and skin creams and soaps that contain fragrance are potential offenders.

Look for products that are free of any flare-up triggers you know you have.

It can be hard to avoid getting psoriasis on your hands completely. These tips may help:

• Take your medications as prescribed. Don’t miss any doses.
• Keep your skin moisturized throughout the day.
• Apply an emollient moisturizer to your hands before bed.
• Avoid psoriasis triggers whenever possible.
• Limit the duration of showers and baths.
• Bathe in warm rather than hot water.
• Use a dishwasher rather than washing dishes in the sink.
• Use a humidifier to moisturize dry air in your home.
• Wear gloves to protect your hands from extreme weather.
• Avoid sunburning your hands.
• Find ways to lower stress.
• Avoid getting sick by wearing a mask in crowded environments.

Psoriasis can affect multiple areas of your hands, including your palms, backs of hands, fingers, and nails. If you have hand psoriasis, you may experience pain, itching, and other symptoms.

There are many treatments for hand psoriasis, and they’ll depend on how severe your symptoms are. Talk with a healthcare professional about how to lower symptoms and treat hand psoriasis.