Different types of psoriasis can affect your palms, hands, fingers, and fingernails. Treatment may depend on where on the hand you have symptoms.

If you have psoriasis, flare-ups may affect your hands and nails. Your hands are in constant use and often visible. This can make psoriasis symptoms such as pain, swelling, and scaling especially challenging.

Read on to find out what psoriasis on the hands looks like and how to manage it.

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

Palmoplantar psoriasis

Palmoplantar psoriasis affects the skin on the palms of your hands and the soles of your feet. The National Psoriasis Foundation reports that this potentially debilitating condition occurs in 12% to 16% of people with psoriasis according to research.

Palmoplantar psoriasis can cause symptoms that include:

  • 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 some scientists may consider it a separate condition.

Still, palmoplantar pustulosis and psoriasis seem to occur together frequently. The National Psoriasis Foundation reports that some research indicates that about 16% of people with palmoplantar pustulosis also have chronic plaque psoriasis.

Research shows that palmoplantar pustulosis affects roughly 0.01% to 0.05% of the population and is most likely to affect females who smoke cigarettes.

Symptoms of palmoplantar pustulosis can 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 nail changes.

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 skin, psoriasis on the backs of your hands may look red or pink with silvery-white scales. On skin of color, psoriasis may look purple or brown with gray scales.

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), a condition that features extreme swelling and inflammation.

The National Psoriasis Foundation reports that research indicates around 90% of people with psoriasis will get nail psoriasis during their lifetime.

Nail psoriasis is sometimes a symptom 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.

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

OTC topical creams

Topical creams are creams 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, both approved by the Food and Drug Administration (FDA) for treating psoriasis.

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.

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

For some people, these ingredients may increase irritation and dryness.

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 are not 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 (dithranol): This medication can slow 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 nonsteroidal cream works by reducing inflammation.

Light therapy (phototherapy)

Light therapy, also known as phototherapy, 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 prescribe 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, which treat the entire body and are taken by mouth, injection, or intravenously (IV). 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 soften your skin by hydrating it and eliminating scales. These creams may be beneficial 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

While protecting your skin from the sun is important, sun exposure in small doses (10 to 15 minutes) can provide helpful UVB light. Just be careful to avoid burning your skin and then moisturize it afterward. Doctors and other healthcare professionals do not recommend tanning beds for this purpose, as they provide more UVA than UVB light.

Before increasing your sun exposure, it’s best to talk with the doctor treating your psoriasis.

Some medications may increase your sensitivity to the sun, and sunburn may also trigger flares.

It’s best to avoid peak UV radiation hours, typically between 9 a.m. and 3 p.m. during standard time and 10 a.m. and 4 p.m. during Daylight Saving Time (DST).

While you should apply sunblock with care, it’s best to avoid putting it on the location of an active flare.

Avoid irritants and triggers

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

Look for products that are free of any known flare-up triggers.

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

  • Take your medications as prescribed. Try not to miss any doses.
  • Keep your skin moisturized throughout the day.
  • Apply an emollient (skin-softening) moisturizer to your hands before bed.
  • Avoid psoriasis triggers whenever possible.
  • Limit how long you spend in the shower and bath.
  • Bathe in warm rather than hot water.
  • Use a dishwasher rather than washing dishes in the sink.
  • Use a humidifier to continually moisturize dry air in your home.
  • Wear gloves to protect your hands from extreme weather.
  • Avoid sunburn on your hands.
  • Try to reduce stress.
  • Avoid illness by wearing a mask in crowded environments.

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

Many treatments help manage hand psoriasis, but they’ll depend on how severe your symptoms are.

Talk with a healthcare professional to learn about how to lower symptoms and treat hand psoriasis.