Psoriasis on the Hands and Feet: Types, Symptoms, and Treatments
Skin ConditionsPsoriasis

Psoriasis on the Hands and Feet: Types, Symptoms, Treatments

Psoriasis on the Hands and Feet: Types, Symptoms, Treatments
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Updated on November 24, 2025
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From a young age, Steven Levy had an idea of how dramatically psoriasis can impact physical and mental health. “My dad had it,” recalls Levy, a TV producer in Los Angeles. “Growing up, I watched him be very self-conscious about it.”

So, Levy wasn’t all that surprised when, in college, he was also diagnosed with psoriasis, an autoimmune disease with a strong genetic link. The worst flare-ups were on his scalp — “I think it would’ve been hard for people not to notice,” he says, referencing the flakes on his shirt — but he also developed psoriasis on his fingernails and his feet.

While flare-ups anywhere on his body were problematic, Levy found that those involving his hands and feet had a unique impact.

Types of Hand and Foot Psoriasis

Plaque psoriasis is the most common psoriasis type, usually appearing on the elbows, knees, lower back, and scalp. But it can show up on any part of the body, including the hands and feet.

This kind of psoriasis is characterized by thick, scaly patches of skin. “On white skin, you’ll see redness or salmon-pink patches. On darker skin, you may not see the red as much; instead, the skin can look hyperpigmented, appearing brown or purple in color, depending on skin type and skin tone,” explains Jeffrey Cohen, MD, MPH, an associate professor of dermatology and the director of the psoriasis treatment program at Yale Medical School in New Haven, Connecticut.

When plaque psoriasis affects the palms of your hands and the soles of your feet, it’s called palmoplantar psoriasis and typically presents as thick plaques with distinct borders and deep fissures or cracks.

 It can also affect the tops of your feet (the dorsal side of the foot) and your toes.

Nail Psoriasis Is Often an Issue

Another type of psoriasis that affects the hands and feet is nail psoriasis. “This can be challenging to treat since it’s difficult to get medications underneath the nails, to the matrix beneath the surface, where nails are made,” says Dr. Cohen.

Although nails take up a relatively small amount of the body’s surface area, they can create major discomfort. According to Cohen: “The nails can thicken, lift up, or get little divots.”

That’s what Levy experienced. “My fingernails became pitted, which I later learned can be a warning sign for psoriatic arthritis,” he says.

 According to research, nail symptoms may affect up to about 80 percent of people with psoriatic arthritis.

Pustular Psoriasis Can Affect Palms and Soles

There are other, rarer types of psoriasis that can affect the hands and feet. “Some people develop pinpoint-size white bumps, or pustules, on the surface of the skin, which can appear on the palms of the hands or on the soles of the feet,” says Elisabeth Richard, MD, an assistant professor of dermatology at the Johns Hopkins University School of Medicine in Baltimore.

As to why psoriasis develops on the hands and feet, Dr. Richard suggests, “It’s possible that it has to do with a process known as Koebnerization, which links trauma such as banging or frequently rubbing an area to flare-ups.”

Symptoms of Hand and Foot Psoriasis

Psoriasis flare-ups on the hands and feet can be hard to live with, for some obvious and not-so-obvious reasons. “Often, there’s intense itching — that can be extremely debilitating,” says Cohen.

And because psoriasis can thicken the skin, a phenomenon known as hyperkeratosis, it’s easy for painful cuts or fissures (cracks) to develop, especially in cold weather.

These symptoms can pose obstacles that make everyday life stressful. With hand psoriasis, “Activities like typing can become difficult,” according to Cohen.

Levy had flare-ups on the knuckles of his toes, which were initially itchy and eventually became raw and painful. “After I walked for a while, I would really start to feel it,” he says. According to the National Psoriasis Foundation, people with palmoplantar psoriasis are almost twice as likely to report mobility problems and almost 2.5 times more likely to report trouble performing daily activities.

Hand and Foot Symptoms Can Affect Emotional Health

In a study of more than 4,000 U.S. psoriasis patients surveyed over the span of three years, researchers found that psoriasis involving special areas of the body, such as the hands and feet, is associated with worse quality of life, depression, and greater limitation in ability to participate in social roles and activities. And the association between these adverse effects and psoriasis in special locations remained even when controlling for age, sex, and disease severity.

When psoriasis appears in a place as obvious as the hands, it causes a lot of social stress. “My patients with psoriasis on their hands tell me all the time that people are reluctant to give them a handshake,” says Richard, who emphasizes that psoriasis is definitely not contagious.

“But it’s tough to go about your life if you don’t want people to see your hands,” Cohen acknowledges.

According to research, people with psoriasis are 1.5 times more likely to show depressive symptoms and experience a higher prevalence of anxiety symptoms (from 20 to 50 percent higher) than people without psoriasis.

 While depression in psoriatic patients has been attributed to living with a visible and uncomfortable condition, scientists have also found evidence that depression associated with psoriatic disease is linked to a specific inflammatory pattern, causing neuroinflammation that leads to depression and anxiety.

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Treatment for Hand and Foot Psoriasis

The first-line treatment for psoriasis on the hands and feet (and other areas of the body) is typically topical steroids alternated with topical anti-inflammatories. These topical steroids include augmented betamethasone, clobetasol, or halobetasol.

 Nonsteroidal topicals don’t thin the skin like steroids can, says Richard.
Topical vitamin D analogs (calcipotriene) and topical retinoids (tretinoin, tazarotene) may be used in addition.

Light therapy can be a good option when psoriasis is localized as opposed to all over the body. “Light therapy is a well-established treatment that’s been in use for over 40 years. It’s a nice drug-free alternative that works well for some people,” says Richard.

Other options for moderate to severe psoriasis are systemic treatments, including methotrexate and a class of drugs known as biologics, which are administered either through injection or intravenously.

 These medications target underlying inflammation by suppressing the body’s immune response, but they can sometimes cause side effects. Patients and doctors need to work closely together to decide whether these medications are the right choice.

“Usually, we reserve biologics for people with moderate and severe psoriasis, when anywhere from 7 to 10 percent of the body is affected,” says Richard. “But the hands and feet can be a special case since they are so essential to a person’s quality of life, so we’ll often go to the more aggressive treatments sooner.”

Trial and Error Is Often Part of the Process in Psoriasis Treatment

Psoriasis patients often find they need to try a number of different treatments before settling on the most effective option. “That’s particularly true for psoriasis on the hands and feet — it’s common for people to go through many medications that don’t work before they find one that does,” acknowledges Cohen.

For Steven Levy, it took seven or eight years to find the right approach. He started with steroid creams: “For me, the impact wasn’t worth the amount of effort it took to apply them twice a day.” He then moved on to methotrexate and, finally, biologics.

“I’d say my psoriasis is now 97 percent better — it’s amazing, and I barely feel the shot,” he says. “When I first got psoriasis, biologics were kind of the last resort, but it seems like there are so many safer options now.”

“One thing I’d like patients to understand is that we have a lot of good options for psoriasis, and they are expanding all the time,” says Cohen. “I’ve seen it with so many patients — we can drastically improve the quality of a person’s life.”

The Takeaway

  • Psoriasis on the hands and feet, including palmoplantar psoriasis, can severely impact everyday activities because of thick plaques, fissures, and intense itching. It's crucial to seek a treatment plan to manage these symptoms effectively.
  • Topical steroids, light therapy, and systemic medications like methotrexate or biologics are potential treatment options. Work closely with a healthcare professional to find the most effective treatment plan — it may require some trial and error.
  • While managing psoriasis can be challenging, treatment options continuously evolve and improve. Engaging in an ongoing dialogue with a healthcare provider can significantly enhance your quality of life.
  • Since psoriasis can affect emotional health and social interaction, especially when visible areas like hands and feet (in warm weather) are involved, look to professionals or support groups for emotional relief and coping strategies.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Palmoplantar Psoriasis. National Psoriasis Foundation. May 16, 2025.
  2. Rasner CJ et al. Diagnosis and Management of Plantar Dermatoses. Journal of the American Board of Family Medicine. April 2022.
  3. How Does Psoriatic Arthritis Affect Your Nails? Cleveland Clinic. December 13, 2021.
  4. Ji C et al. Challenge of Nail Psoriasis: An Update Review. Clinical Reviews in Allergy and Immunology. December 2021.
  5. Blauvelt A et al. Psoriasis Involving Special Areas Is Associated with Worse Quality of Life, Depression, and Limitations in the Ability to Participate in Social Roles and Activities. Journal of Psoriasis and Psoriatic Arthritis. 2023.
  6. Hedemann TL et al. Associations Between Psoriasis and Mental Illness: An Update for Clinicians. General Hospital Psychiatry. March–April 2022.
  7. Mrowietz U et al. Depression, a Major Comorbidity of Psoriatic Disease, Is Caused by Metabolic Inflammation. Journal of the European Academy of Dermatology and Venereology. September 2023.
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Amy Spizuoco, DO

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Amy Spizuoco, DO, is a board-certified dermatologist and dermatopathologist. Dr. Spizuoco has been practicing medical, surgical, and cosmetic dermatology, as well as dermatopathology in New York City for 12 years.

She did her undergraduate training at Binghamton University, majoring in Italian and biology. She went to medical school at the New York Institute of Technology College of Osteopathic Medicine. After medical school, she completed her dermatology residency at Lake Erie College of Osteopathic Medicine–Alta Dermatology in Arizona. During that time she studied skin cancer surgery and pediatric dermatology at Phoenix Children’s Hospital and attended dermatology grand rounds at the Mayo Clinic in Scottsdale. After her residency, Spizuoco completed a dermatopathology fellowship at the Ackerman Academy of Dermatopathology.

She was previously an associate clinical instructor in the department of dermatology at the Icahn School of Medicine at Mount Sinai in New York City. She is on the editorial boards of Practical Dermatology and Dermatology Times.

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Paula Derrow is a writer and editor in New York City who specializes in health, psychology, sexuality, relationships, and the personal essay. She was the articles director at Self magazine for 12 years, and has worked at many other national magazines, including Glamour, Harper’s Bazaar, and American Health. Her writing has been featured in The New York Times Ties column, its Modern Love column, Refinery29, Real Simple, Tablet, Cosmo, Good Housekeeping, Woman’s Day, and more.

Derrow also covers health for New York Presbyterian/Weill-Cornell Hospital in New York City. She has ghost edited a number of health books and health-related memoirs. She is the editor of the Publisher’s Weekly-starred anthology Behind the Bedroom Door: Getting It, Giving It, Loving It, Missing It.

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