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

Unique Challenges

Hand and foot psoriasis can wreak havoc with self-esteem as a patient's confidence is eroded by the unsightly and embarrassing appearance of the disease on the hands and/or feet. Patients may also develop feelings of worthlessness.

In addition to the enormous emotional burden, the disease also impairs a patient's basic day-to-day activities. Many patients are unable to wear shoes comfortably or use their hands. One male patient recently lost his job because he could not perform his job responsibilities due to the psoriasis on his hands. A female patient in her 20s lost her mid-level position because she had to wear flip-flops to work. Her feet were cracked and bleeding due to psoriasis on her feet, which made wearing shoes difficult. Psoriasis also impacts other activities of daily living. Simple daily activities such as sewing, using a computer, or walking in the park can be difficult for individuals suffering from the pain and discomfort that accompany hand and foot psoriasis.

Socially, the disease can take an enormous toll, causing dysfunction in relationships and sexuality. A female patient stated that her young children were reluctant to hold her hands because of the condition, while a male patient with hand psoriasis told us he had not touched his wife in months. We are aware of another patient, not in our practice, who achieved almost total clearance of the psoriasis covering a large portion of her BSA, yet highly visible patches remained on her hands. While her physician viewed this case as a treatment success story, the patient herself was too embarrassed to eat at a restaurant, shop for clothes, pay the bill at a store, or engage in any activities that would require public use of her hands.

Hand and foot psoriasis may also be a causative factor in co-morbidities. For example, hyperkeratotic fissured plaque psoriasis on the feet can limit a patient's ability to take part in physical activity, which in turn may contribute to weight gain. A recent study found that 71% of patients with psoriasis became overweight or obese after onset of the disease (Herron et al., 2005).

Psoriasis severity is measured in terms of both the physical and emotional impact of the disease. The American Academy of Dermatology considers psoriasis "severe" if more than 10% of the body is affected, "moderate" if the condition affects 3% to 10%, and "mild" if less than 2% of the body is involved. How ever, psoriasis can be considered "severe" if it greatly hinders a patient's quality of life, even if it only physically affects a small area of the body (like the palm of the hand, which is equivalent to about 1% of the body's surface area) (Callen et al., 2003).

Patients with hand and foot psoriasis should be viewed in a different light than patients with generalized psoriasis for a number of reasons. As the NPF (2007) points out, psoriasis in general is often misunderstood by the public, which can make social interaction difficult and affect the type of work people do if the disease is visible. Psoriasis involving the hands and feet may be highly visible in social and work environments, leading to anxiety and embarrassment for the patient. This form of the disease impairs patients' ability to perform functions of daily living, impacts them financially, and takes away their self-worth.

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