Could Your Inflamed, Irritated Hands Be Signaling Psoriasis?

Those who work with their hands are most likely to have the condition, such as farmers, manual laborers, massage therapists, and environmental services professionals.

Why do flare-ups happen?

Many of the potential causes for hand psoriasis are also triggers for the condition, but there are a few other things that can cause a flare-up. Pay special attention to seasonal changes, household work, laundry detergent, and stress, as these can all make hand psoriasis worse. (Seriously, does stress make anything better?) Another thing to consider is whether your nightly glass of wine has anything to do with psoriasis flare-ups. According to one 2019 study published in the journal Psoriasis, drinking alcohol has been linked to flare-ups in general, not just on the hands.4 

On the physical stress side, some people experience psoriasis on their hands due to their occupation. Appropriately called occupational contact psoriasis, it causes flare-ups due to constant mechanical pressure on the skin from working with the hands as well as working with irritants. Drivers, cashiers, construction workers, dentists, and even pharmacists are at risk (due to frequent handling of bottle caps with a twisting motion), according to a 2020 study published in Occupational Dermatology.5 In this case, your job is causing the problem (but you probably knew that already).

It’s tough when your livelihood is causing your hand psoriasis symptoms. Talk to your doctor or workplace if there may be adjustments that could reduce your flare-ups. Examples include protective gloves, padding tools, or re-assignment to a different job duty.

If you have both eczema and psoriasis on the hands, your doctor may recommend allergy testing to help identify what could worsen your symptoms. Avoiding these allergens may help to minimize psoriasis flare-ups.

How is hand psoriasis diagnosed?

It would be really easy if doctors could take a skin sample and know without question what kind of skin issue you were dealing with. Of course, it’s unfortunately not that simple if you potentially have psoriasis on your hands.

“While biopsies can help confirm psoriasis on other parts of the body, it’s not a good test when we are trying to differentiate it on the hands and feet,” Dr. Rosmarin explains. It’s really important to look at the symptoms, he says.

That’s not to say that a doctor may not recommend taking a biopsy if they want to try another diagnostic option. There aren’t a lot of studies about the differences between eczema and palmar psoriasis under a microscope, but a smaller 2015 study published in The Journal of Dermatology found there were some key differences. These include white-to-gray scales for those with palmar psoriasis or brown-orange dots for those with hand eczema.6

What are hand psoriasis treatments?

You probably already know that psoriasis on the hands can be challenging to treat. While that can feel a little disheartening, know that there are still lots of options to try.

“There are some treatments, such as certain topical creams or ointments, that can help with both psoriasis and eczema,” Dr. Rosmarin says. “The immune system is too active in the skin, so we have medicines that can tell the immune system to calm down.”

You’ll likely try topicals first.

Typically, the first-line treatment for psoriasis plaques on the hands is topical corticosteroids, which come in the form of anti-inflammatory creams, ointments, or gels. Sometimes, a doctor may recommend applying this with occlusion—this means wearing gloves or wrapping the hands, ideally to allow the medication to better penetrate. Other times, your dermatologist will recommend combining this medication with calcipotriene, an ointment that helps to slow skin cell growth.