Psoriasis on the hands

Psoriasis can be localized on different parts of the body, and hands are no exception. The disease does not pose a threat to life, but it greatly affects the quality of life. If the disease has become severe, complications arise: impaired joint mobility, psoriatic arthritis may develop. And this is a very serious problem that affects motor function and can even lead to disability. To cure psoriasis on the hands, you need to be very patient: it will take a lot of time. But people suffering from this disease are ready to spend both time and effort to cope with it. Psoriasis usually affects the hands, elbows, torso, and scalp. It can be localized on the folds of the limbs, in the groin, under the arms. Manifestations of psoriasis on the hands are difficult to hide from curious glances in everyday life, they look frightening to others, so this is also a question of social adaptation.

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Epidemiology

The total number of people with psoriasis on the planet is approximately 100 million. The first signs are noted quite early: on average, at 16 years of age in women and at 22 years of age in men. This type of psoriasis, which affects at a young age, develops in 75% of patients and is classified as type 1. In this case, the transmission of psoriasis to descendants can extend to 3-4 generations. More than half of patients have blood relatives who also suffer from psoriasis.

Psoriasis type 2, which develops in people of mature age, is 25% of the total number of patients. The average age when this type of psoriasis appears is 56 years. In such cases, the development of the disease is not associated with genetic predisposition or immune disorders. In such cases, the disease primarily affects the joints and nail plates.

Interestingly, the disease is less common in areas where the diet contains a lot of fish (for example, in Japan). This is explained by the fact that fish contains a large amount of ω3-polyunsaturated fatty acids, which are known for their anti-atherogenic properties.

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Causes psoriasis on the hands

The main cause of psoriasis on the hands is considered to be a hereditary predisposition. In first-degree relatives, who at first glance seem healthy, a latent form of psoriasis is often found, when the structure of the capillaries in the epidermis changes. In half of patients, exacerbations of the disease are associated with stress.

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Risk factors

In addition, there are other risk factors that can trigger the chain of disease development:

• Disruption of the body's immune system;
• Consequence of infectious diseases;
• Hormonal diseases (hyperthyroidism, diabetes mellitus);
• Metabolic disorders;
• Stress, emotional shock;
• Tendency to allergic reactions;
• Mechanical injuries to the skin;
• Exposure to aggressive substances (household chemicals, solvents, paints).

All of the above factors indicate that there is no reliable data on the etiology and pathogenesis of the disease, just as there is no evidence of the retroviral nature of psoriasis.

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Pathogenesis

T-cell hyperactivity is assumed in the pathogenesis. In particular, the epidermis is infiltrated by a large number of activated T-cells, which are capable of inducing keratinocyte proliferation, the synthesis of various cytokines (for example, tumor necrosis factor α [TNF-α], gamma interferon, interleukin-12), and proinflammatory mediators (IL-17/23).

In the affected skin of patients with psoriasis, there is a blockage and alteration of the epidermal cell cycle. Epidermal hyperplasia leads to abnormal maturation of cells.

Genetic predisposition to the disease is being studied. The gene locus responsible for psoriasis is being studied.

Psoriasis is associated with certain alleles of human leukocyte antigen (HLA), particularly human leukocyte antigen CW6 (HLA-CW6). In some families, psoriasis is an autosomal dominant trait.

A multicenter meta-analysis confirmed that the LCE3C and LCE3B genes are a common genetic predisposition factor for the development of psoriasis in different populations.

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Symptoms psoriasis on the hands

The first signs of psoriasis are single inflammations on the skin. The affected hands also look very different in different patients. Some have spots of different sizes, others have psoriasis of the fingernails, when the nail plate peels off. With psoriasis, swelling of the joints can usually be noticed. At the same time, the skin dries out, new cracks appear on it, which then turn into inflammation.

Of the total number of patients, approximately 25% have psoriasis on the hands and feet. The clinical signs of psoriasis are similar to mycosis and eczema, so a definitive diagnosis can only be established based on the results of a biopsy.

The lesions look like round plaques with easily detachable scales. The lesions themselves are bright red and stand out on the skin.

The main symptoms of psoriasis are: dry skin surface, in the affected areas it is reddened and thickened, small cracks may be visible. On such skin, formations similar to calluses with a rim are formed. Later, they can merge with each other and form significant lesions in area.

Is psoriasis on the hands contagious?

There is no consensus in medicine on this issue. But most doctors are inclined to believe that psoriasis is a hereditary disease, the trigger for which are viruses, infections and other factors. Is psoriasis on the hands contagious? Definitely not!

Of course, contact with a patient with psoriasis can cause unpleasant feelings based on aesthetic and hygienic considerations, but you cannot become infected from such a person.

Stages

The development of the disease goes through the following phases:

1. Progressive. The initial stage is characterized by the appearance of many small elements on healthy areas of the epidermis, which have light scales in the center and an erythematous border. Then the rash grows and psoriatic plaques appear.
2. Stationary. This stage is characterized by the fact that skin rashes no longer appear, existing plaques do not grow, and the entire surface of the rash peels.
3. Regressive. Psoriatic plaques become flat, peeling is not so strong and the elements even dissolve, and in these areas the skin remains without pigmentation.

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Forms

There are many types of psoriasis, but they can all be divided into two groups, and within them a number of subgroups can be distinguished:

1. Pustular type, covering:
   • generalized form;
   • palmar-plantar form;
   • psoriasis of the annular centrifugal erythema type.
2. Non-pustular type, including:
   • classic psoriasis with late or early onset;
   • psoriatic erythroderma.
3. There are other types of psoriasis that are not included in this classification:
   • seborrheic form;
   • exudative form;
   • drug-induced psoriasis;
   • Napkin's disease;
   • atypical psoriasis, when lesions are localized on the folds of the limbs.

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Differential diagnosis

Due to the variety of clinical manifestations, the diagnosis of psoriasis on the hands is complicated by the fact that the disease must be differentiated from many types of dermatoses, such as lichen erythematosus, syphilis, parapsoriasis, seborrheic and atopic dermatitis, and Reiter's disease.

For certain conditions, it is easier to conduct differential diagnostics based not on diagnoses, but on the form of the disease. For example, psoriasis on the palms and feet is differentiated from dermatophytosis, dyshidrotic eczema, and keratoderma.

Rashes resembling psoriasis may occur due to drug-induced toxicoderma.

Arthropathic psoriasis must be differentiated from arthritis and arthrosis.

Generalized pustular psoriasis must be distinguished from bacteremia. For this purpose, one of the instrumental diagnostic methods is used – blood culture for bacteria.

Sometimes it is necessary to take tests for HIV, since psoriasis can manifest itself due to the human immunodeficiency virus.

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Treatment psoriasis on the hands

Nowadays, there are many different means for treating the disease. Time-tested means are widely used, and the latest developments are just beginning to gain wide recognition. Some of them are worthy of special mention. We will try to provide complete information about both.

To eliminate the manifestations of psoriasis, it will take a significant amount of time and complex measures. Modern medicine cannot cure psoriasis completely. Surgical treatment is used only in extreme cases - when the joints are severely damaged and endoprosthetics are required. And in this case, it turns out to be ineffective, if, for example, compared with the effectiveness of operations in patients with rheumatoid arthritis.

The main goal of treatment is to reduce the lesions and ensure that the disease enters the remission stage. Complex treatment maximizes the number of targets to achieve the best result. Complex measures imply general, local treatment and treatment with physiotherapeutic methods.

Medicines are selected based on data on the prevalence of inflammation, the phase of psoriasis, the patient's age and other existing chronic diseases.

Local drug treatment of the disease is aimed at stopping pathological processes in the skin. For this purpose, agents containing sulfur, salicylate, urea, naphthalan, tar and topical glucocorticosteroids are used. These drugs are presented in the form of creams, ointments and aerosols.

Glucocorticosteroids

In the progressive phase of the disease, 1-2% salicylic ointment and local glucocorticosteroids are often used. If this is another relapse with severe inflammation, more effective ointments for psoriasis on the hands are used, containing fluorinated glucocorticosteroids, for example, betamethasone cream 0.025-0.1%, triamcinolone acetonide cream 0.025-0.1% or non-halogenated glucocorticoids. However, the use of powerful glucocorticosteroids is dangerous due to the high risk of complications and the withdrawal effect, when the disease worsens when the use of drugs is stopped. Therefore, fluorinated glucocorticosteroids are prescribed in extreme cases. Long-term treatment with these drugs leads to skin atrophy, excessive hair growth that is not typical for this area of the skin, the development of other systemic side effects and complications. Therefore, it is essential to consult a specialist about the dosage and duration of treatment and strictly follow his recommendations.

Calcipotriol

A good effect is achieved by using drugs whose active substance is calcipotriol. Such drugs give results comparable to those from the use of glucocorticosteroids, but they do not provoke the development of atrophic processes in the skin and they are not characterized by the development of the withdrawal effect. But calcipotriol in almost all cases causes a burning sensation on the treated skin, therefore, at the initial stage of treatment, it is combined with glucocorticosteroids. Later, only calcipotriol is used. This treatment regimen has its own logic. At the initial stage (the first 2-4 weeks), the patient uses calcipotriol and glucocorticosteroids, and after receiving a stable result, switches to treatment without hormonal components. Both medications are used once a day. The maximum daily dose of the drug with calcipotriol should not exceed 15 g. The effect of the treatment will be noticeable after 1-2 weeks. The duration of treatment should not exceed 8 weeks.

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Preparations based on tar and naphthalene

They are quite effective and relatively safe for long-term use. In addition, the cost of such treatment will be affordable for anyone.

But there are some limitations to using these products. They are not recommended for use in psoriasis at a progressive stage and on large areas of skin: as a result, they can only aggravate the course of the disease. In addition, tar and naphthalene-based medications can cause complications in chronic diseases of the excretory organs.
Many experts believe that the optimal treatment is the alternate use of local drugs, since due to the skin's addiction to any drugs, they lose their effectiveness with long-term treatment.

General treatment for progressive psoriasis begins with injections of antihistamines. In addition, sodium thiosulfate (3-10 ml every day) or 5% unithiol solution (3-10 ml every other day) or 10% calcium chloride solution (5-10 ml every day) are administered intravenously. Additionally, sedatives are prescribed and a course of vitamin treatment is carried out: vitamin D analogues (for example, calcitriol ointment, calcipotriene, calcipotriene)

In some cases, patients are prescribed the drug infliximab. Since the version of the autoimmune nature of psoriasis is not refuted, this immunosuppressant is recognized as one of the most effective for psoriasis that affects the joints. The drug is administered intravenously, the dosage is 3-5 mg / kg. The duration of treatment depends on the severity of the disease.

In addition, there are also other drugs from the arsenal of "heavy artillery" - aromatic retinoids (for example, tazarotene aqueous gel 0.05% and 0.1%).

Other medicines:

• Immunomodulators (eg, cyclosporine 0.1%, alefacept, ustekinumab).
• Keratolytic agents (eg, anthralin).
• Antimetabolites (eg, methotrexate).
• TNF inhibitors (eg, etanercept, adalimumab).
• Phosphodiesterase-4 inhibitors (eg, apremilast).

After an effective course of therapy, psoriasis goes from the acute stage to the chronic stage. Since it cannot be cured completely, as well as predicting the further development of the disease, it is not possible to make an accurate prognosis.

Folk remedies

Treatment of psoriasis on the hands using folk methods is aimed at detoxifying the body and restoring the skin with the help of healing baths, creams and compresses.

Good results are shown by the use of bee products, as well as medicinal plants: calendula, chamomile, celandine, pine needles, oak bark, licorice and succession.

To cleanse the body, it is recommended to drink special teas: viburnum, rowan, raspberry, lemon. And herbal decoctions will not only help the body cleanse itself, but also eliminate inflammation and have a choleretic effect.

Proven recipes of traditional medicine for the treatment of psoriasis on the hands:

1. In the evening, pour a glass of boiling water over a glass of flax seeds. Drink the infusion on an empty stomach in the morning.
2. Apply birch tar to the affected areas. Keep the compress for at least an hour, then wash off and treat with celandine decoction. Several such compresses will already give a noticeable result.
3. Apply solidol to the affected areas in the evening before going to bed.
4. Apply flaxseed oil, rich in vitamins A and E, to the affected areas. This will help relieve inflammation and promote skin regeneration.
5. With psoriasis, the skin's acid-base balance is disrupted. To restore it, you can use baking soda.

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Herbal treatment

When using herbs, it is important to follow the recipe and dosage, and to use infusions and decoctions exactly as described.

1. An effective remedy is celandine juice. It is squeezed out of a fresh plant and applied to the skin areas affected by psoriasis. The course of treatment is 3 months.
2. Sunflower compresses. For this, take young sunflower heads, which are then ground. If necessary, you can add a little water. The compress is applied to the affected skin. Sunflower eliminates inflammation and prevents the development of pathogenic flora.
3. Medicinal baths. For psoriasis, baths with decoctions of celandine, lavender, chamomile, mint, and linden are recommended.

You can experiment with natural remedies: alternate and look for optimal recipes. Traditional medicine recipes as an additional remedy in complex therapy can be quite effective.

Homeopathy and Psoriasis

Homeopathic medicines are also a popular method of treatment. Homeopathy takes into account the specifics of psoriasis and its various manifestations and factors that triggered the pathological process, since homeopathic medicines are selected based on the patient's constitutional structure. During such treatment, the body is reconfigured, that is, the body's own resource works to restore balance.

Homeopathic treatment is often combined with organotropic drugs that have a special effect on certain organs.

A special place in the series of dermatotropic agents belongs to the preparations Acidum nitricum, Arsenicum iodatum, Calcium carbonicum, Kalium arsenicosum, Sepia, Silicea, Sulfur, Thuja.

Prevention

To prevent exacerbations, it is recommended to adhere to a certain diet, where carbohydrates and polyunsaturated fatty acids are limited, but there is a lot of seafood and vegetables.

The patient's skin also requires special attention. For daily care, you should arm yourself with moisturizing creams. They will restore the damaged protective mantle of the epidermis. These products should be used daily or even several times a day. It is best to use medicinal cosmetics intended for atopic skin and cosmetics that contain salicylic acid and urea.

If the first signs of psoriasis on the hands appear, the first thing to do is to minimize skin contact with aggressive substances and mechanical impact. Pay attention to the skin on the joints: cracks often appear in these places. In half of the cases of psoriasis of the hands, the nails are also affected. With psoriasis, the nails become thicker, break more easily, and even completely peel off. If the lesion occurs at the base of the nail plate, it will be difficult to cope with it, because in this case there is almost no air access to the nail. In addition, you should ensure that the skin of the hands does not remain wet after contact with water: moisture aggravates inflammation.

The manifestations of psoriasis on the hands, which can vary greatly, and the characteristics of the disease in each individual case make it difficult to determine a treatment plan. In some cases, remarkable results are achieved exclusively by traditional medicine. In other cases, a combination of traditional methods with folk remedies will be more effective. The final word in choosing the therapeutic measures that are optimal in each case should remain with the attending physician.

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