Psoriasis on the Hands: Palms, Nails, and Early Signs

Psoriasis is a chronic non-infectious skin disease in which skin cells renew too quickly. On the hands it manifests in different ways: from scaly patches on the palms to pinpoint depressions on the nails. Let us examine how psoriasis manifests on the hands and nails.

What psoriasis on the hands is

Psoriasis is a dermatosis in which the skin produces more cells than usual, and patches form on the surface. Normally a skin cell rises to the surface within a month; in psoriasis, within just a few days. The cause is a malfunction of the immune system; heredity increases the likelihood. The disease does not depend on sex and occurs in 2–4% of the population. It is not contagious — you cannot catch it or pass it on. The disease runs in waves: flare-ups alternate with improvements.

What psoriasis on the hands and palms looks like

The main sign is dry, itchy, and painful patches that look like silvery-white scales. The size is usually 1–2 cm, the shape oval or irregular. On light skin the patches are pink or red, then silvery-white, sometimes acquiring a waxy yellow or orange-brown hue; on dark skin they are gray and leave dark marks after healing. Most often plaques appear on the head, elbows, forearms, knees, and in skin folds, but they can also be on the palms. On the palms, multiple small brown and yellow dots are often visible.

• Patches 1–2 cm with silvery-white scaling on the palms and fingers.
• Multiple small yellow and brown dots on the palms.
• Pits and depressions on the nails, thickening of the nail plate.
• Itching, dryness, and soreness of the skin of the hands.
• Periodic pain and swelling of the joints.

Palmoplantar psoriasis: what it is

This is a separate form in which the skin of the palms and soles is affected. In the classification it is assigned to the pustular variants — chronic persistent acrodermatitis.

Nail psoriasis: how it begins

The nails are often involved, sometimes without any skin manifestations. Early nail psoriasis looks like small depressions and pits on the nail surface, thickened whitish areas closer to the tip. Nail changes are called psoriatic onychodystrophy. In some people, psoriatic arthritis — inflammation of the joints, which affects 10 to 15% of patients with psoriasis — develops with age.

How psoriasis of the hands differs from eczema and fungus

Psoriasis is difficult to diagnose precisely because it resembles other skin diseases. The key difference from eczema is the location: eczema more often affects the inner flexor surface of the elbows and knees, while psoriatic plaques affect the outer, extensor surface. Pits and depressions on the nails have been described in nail psoriasis, but psoriasis resembles other skin diseases, so the diagnosis is made by a doctor.

Diagnosis and when to see a dermatologist

The doctor examines the skin and nails; if necessary, a small sample of skin is taken and examined under a microscope. You should consult a dermatologist if symptoms of psoriasis appear, if the prescribed treatment does not work or causes side effects, and also with recurring pain, stiffness, and swelling of the joints.

This alone is not a reason to call an ambulance; 103 or 112 — if the skin rapidly reddens and white pustules appear that merge with each other, if the patches on the feet turn yellow and fill with pus, if red scaly pustules appear on the tips of the fingers and toes — especially against a background of rapid heartbeat or high temperature.

Psoriasis is a chronic condition with periods of flare-ups and improvements; the approach to it is selected by a doctor. The material is for reference and does not replace a consultation with a dermatologist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer