Give Them a Hand: Patients With Hand and Foot Psoriasis Require Special Attention

Linda Daus, RN, CCRC

Disclosures

Dermatology Nursing. 2008;20(4):291-293. 

In This Article

Abstract and Introduction

Hand and foot psoriasis impairs patients´ ability to function, impacts them financially, and chips away at their self-worth. Dermatology nurses play an important role with these patients in improving their quality of life through support, counsel, education, and meeting their medical and emotional needs.

Psoriasis is an autoimmune disorder that occurs when skin cells grow abnormally, producing thick, red, scaly, and inflamed patches on the skin. Plaque psoriasis, the most common form of the disease, affects approximately 6 million Americans and is characterized by lesions topped with silvery white scales (National Psoriasis Foundation [NPF], 2007). The disease can be limited to a few spots or involve extensive areas of the body. It appears most commonly on the scalp, knees, elbows, and trunk.

Psoriasis is often misperceived as a cosmetic disease. At Central Dermatology, we view psoriasis as being equal or greater to heart disease or cancer in its impact on a patient's life. It is a chronic and serious condition that must be monitored and managed continuously.

The objective of this manuscript is to address psoriasis involving the hands and feet, and how this particular form of the disease is not only more challenging to treat but also causes serious physical, quality of life, and self-image problems, even in patients whose disease has largely been cleared from the rest of their body surface area (BSA).

Psoriasis involving the hands and feet affects only about 30% of patients with plaque psoriasis, but is a uniquely problematic form of the disease (Fretzin, Crowley, Jones, Young, & Sobell, 2006). The impact of hand and foot psoriasis on patients' quality of life is extremely high. While these individuals may have a relatively small BSA involved, the location of the lesions often prevents patients from participating in everyday activities and the visibility of the disease weighs heavily on emotions and self-image. Unlike many other forms of this disease, hand and foot psoriasis is difficult to treat and often refractory to multiple therapies, even those that are effective in generalized psoriasis. Patients with hand and foot involvement are affected to a greater degree by physical aspects of the disease (such as pain, discomfort, cracking and bleeding of the skin) than patients without lesions on the hands and feet (Pettey, Balkrishnan, Rapp, Fleischer, & Feldman, 2003). While modest success has been achieved with most conventional treatments (such as phototherapy), the toll that hand and foot involvement can take on a patient physically, psychosocially, and even economically requires that the bar for treatment success be raised when treating this specific subpopulation.

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