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What Causes Psoriasis on the Hands?

Psoriasis is a skin condition that causes the skin to be red, thick, scaly, and flaky. When a person has psoriasis on the palms of the hands or soles of the feet, it's called palmoplantar psoriasis. Psoriasis on the hands may be caused by an overactive immune system. Risk factors may include family history, infections, medications, smoking, and obesity.
Psoriasis is a skin condition that causes the skin to be red, thick, scaly, and flaky. When a person has psoriasis on the palms of the hands or soles of the feet, it’s called palmoplantar psoriasis. Psoriasis on the hands may be caused by an overactive immune system. Risk factors may include family history, infections, medications, smoking, and obesity.

Psoriasis is a chronic autoimmune skin condition where the body attacks its own cells. It causes skin to be red, thick, scaly, and flaky. 

When psoriasis occurs on the palms of the hands or soles of the feet, it’s called palmoplantar psoriasis. It is one of the most common types and it affects about 40% of people with psoriasis. 

In addition, fingernails and toenails may be affected. Psoriatic nail disease can cause symptoms in both the nail bed and the matrix, the area where fingernails and toenails start their growth. 

Palmoplantar pustular disease (pustulosis) occurs in approximately 5% of patients who have psoriasis and appears as small, pus-filled blisters on reddened, tender skin. It can also cause painful cracking and fissuring.

Psoriasis on the hands and elsewhere on the body is caused by an overactive immune system, but the reason the immune system becomes triggered in some people is unknown. 

Risk factors that may increase the chances of developing psoriasis on the hands include:

  • Family history of psoriasis
  • Some types of infections, such as strep
  • Certain medicines
  • Smoking
  • Obesity

Triggers for psoriasis on the hands include:

  • Stress
  • Skin injury, including scratches, sunburns, bug bites, and vaccinations 
  • Illness, such as ear infection, bronchitis, tonsillitis, or respiratory infection
  • Weather, especially cold weather 
  • Allergies
  • Certain foods
  • Alcohol 
  • Environmental factors

What Are Symptoms of Psoriasis on the Hands?

Symptoms of psoriasis on the hands may include:

  • Patches of skin on the hands that are:
    • Thick, dry, red, or dark
    • Silvery-white scales that itch or burn itchy
    • Scaling, reddened skin plaques
    • Small, pus-filled blisters on reddened, tender skin (palmoplantar pustular disease)
    • Painful cracking and fissuring (palmoplantar pustular disease)
  • Nail changes 
    • Pitted
    • Thick
    • Ridged
    • Crumbly
    • Discoloration
    • White or reddish spots
    • Separation of the nail from the nail bed (onycholysis)
  • Painful swelling of fingers
    • Dactylitis, often called “sausage digits”
    • May also occur in the toes
  • Emotional effects
  • Psoriatic arthritis
    • Compared to plaque psoriasis, psoriatic arthritis occurs more often in patients who have palmoplantar psoriasis
    • Stiff, swollen, painful joints

What Is the Treatment for Psoriasis on the Hands?

There is no cure for psoriasis on the hands, but treatments can relieve the symptoms. Treatments for other types of psoriasis like TNF-alpha inhibitors such as infliximab and adalimumab may trigger palmoplantar pustulosis so they are generally not recommended.

Topical treatments are used for mild psoriasis on the hands, such as:

  • Emollients: thick, greasy barrier creams to moisturize dry, scaly skin and help prevent painful cracking
  • Keratolytic agents such as urea or salicylic acid help thin down thick scaling skin
  • Coal tar: helps improve scale and inflammation    
  • Topical steroids: potent ointment used to reduce inflammation, itch and scaling

Severe cases of palmoplantar psoriasis may be treated with: 

  • Phototherapy 
  • Systemic agents
  • Biologics (targeted therapies)
    • Bathwater PUVA
    • Acitretin
    • Methotrexate

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References
https://www.uptodate.com/contents/psoriasis-the-basics?search=psoriasis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

https://www.psoriasis.org/

https://dermnetnz.org/topics/psoriasis-of-the-palms-and-soles/